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Upper Gastrointestinal Bleeding

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Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial.
Jairath V, Kahan BC, Gray A, Doré CJ, Mora A, James MW, Stanley AJ, Everett SM, Bailey AA, Dallal H, Greenaway J, Le Jeune I, Darwent M, Church N, Reckless I, Hodge R, Dyer C, Meredith S, Llewelyn C, Palmer KR, Logan RF, Travis SP, Walsh TS, Murphy MF.
Lancet. 2015 Jul 11;386(9989):137-44.

Rationale for inclusion: this large cluster randomized trial confirmed the feasibility and safety of a restrictive transfusion trigger (Hgb <8 g/dL) compared to a more liberal trigger (Hgb <10 g/dL) for upper GI bleeding.

Citations - 61 (as of July 2017)

Transfusion strategies for acute upper gastrointestinal bleeding.
Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, Graupera I, Poca M, Alvarez-Urturi C, Gordillo J, Guarner-Argente C, Santaló M, Muñiz E, Guarner C.
N Engl J Med. 2013 Jan 3;368(1):11-21.

Rationale for inclusion: this single-center randomized trial demonstrated that a restrictive transfusion strategy (Hgb trigger <7 g/dL) was superior to a more liberal transfusion strategy for upper GI bleeding.

Citations - 819 (as of July 2017)

Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review.
Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M.
Aliment Pharmacol Ther. 2011 Sep;34(5):509-18.

Rationale for inclusion: this meta-analysis confirms that antibiotic prophylaxis for cirrhotic upper GI bleeding is beneficial for bacterial infections, all-cause mortality, rebleeding events, and hospital length of stay.

Citations - 114 (as of July 2017)

Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure.
Eriksson LG, Ljungdahl M, Sundbom M, Nyman R.
J Vasc Interv Radiol. 2008 Oct;19(10):1413-8.

Rationale for inclusion: this study confirms that after failed endoscopy for upper GI bleeding, arterial embolization should be attempted next before surgical intervention.

Citations - 131 (as of July 2017)

The Canadian Registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting.
Barkun A, Sabbah S, Enns R, Armstrong D, Gregor J, Fedorak RN, Rahme E, Toubouti Y, Martel M, Chiba N, Fallone CA; RUGBE Investigators.
Am J Gastroenterol. 2004 Jul;99(7):1238-46.

Rationale for inclusion: this very large registry study confirms the beneficial role of endoscopy and proton pump inhibitor therapy for nonvariceal upper GI bleeding.

Citations - 376 (as of July 2017)

Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment.
Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, Soulez G.
J Vasc Interv Radiol. 2001 Feb;12(2):195-200.

Rationale for inclusion: this study confirms the safety and efficacy of arterial embolization for upper GI bleeding.

Citations - 217 (as of July 2017)

Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay.
Cooper GS, Chak A, Way LE, Hammar PJ, Harper DL, Rosenthal GE.
Gastrointest Endosc. 1999 Feb;49(2):145-52.

Rationale for inclusion: this study concludes that early endoscopy for upper GI bleeding is beneficial in terms of hospital length of stay, risk of recurrent bleeding, and need for surgery.

Citations - 217 (as of July 2017)

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