P2041 - Nonvariceal Upper Gastrointestinal Bleeding in Patients with Prosthetic Valve: Insights from the National Readmission Database

Khaled Elfert, MD¹, Mahmoud Khalil, MD², Mohamed Ahmed, MD³, Angelina Dhani Mohamed, MD¹, Mouhand FH. Mohamed, MD⁴, Azizullah Beran, MD⁵, Fouad Jaber, MD⁶, Islam Mohamed, MD⁶, Manasik Abdu, MD⁷, Hadi Mirhedayati Roudsari, MD^1
1SBH Health System, Bronx, NY; ²Lincoln Hospital, Bronx, NY; ³University of Missouri Kansas City, Overland Park, KS; ⁴Brown University, Providence, RI; ⁵Indiana University, Indianapolis, IN; ⁶University of Missouri-Kansas City, Kansas City, MO; ⁷University at Buffalo-Catholic Health System, Buffalo, NY

Introduction: In the United States, the prevalence of valvular heart disease is 2.5%, and prosthetic valves are increasingly being used for treatment. Hemorrhagic complications usually arise in patients with mechanical valves, with major hemorrhage occurring in 1-3% of patients per year. Utilizing the National Readmission Database (NRD), we aimed to investigate the clinical outcomes of non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with prosthetic valves.

Methods: We conducted an analysis of the NRD from 2016 to 2019 that included adult patients admitted with NVUGIB. The cohort was divided into two groups based on the presence of an artificial valve. We compared baseline characteristics and clinical outcomes between the two groups.





Results: Our analysis included 807,657 in the non-artificial valve group with NVUGIB and 18,039 in the artificial valve group with the same condition. We observed a higher prevalence of congestive heart failure, kidney disease, hypertension, and cerebrovascular disease in the artificial valve group. Conversely, the prevalence of liver disease, peptic ulcer disease, malignancy, and alcohol abuse was higher in the non-artificial valve group (Table 1).

The rates of mortality (1.4% vs. 2%, P 0.0002), acute respiratory failure, and mechanical ventilation rate were lower in the artificial valve group. Multivariate regression analysis showed that the presence of prosthetic valve is independently associated with lower mortality (OR .055, 95% CI 0.46-0.67) (Figure 1). Conversely, the rates of EGD utilization (41.3% vs. 29.7%, P < 0001) and packed red blood cell transfusion (43.8% vs. 35.1 P < 0.0001) were higher in the artificial valve group. Furthermore, the artificial valve group had a higher rate of all-cause readmission (20.5% vs. 17.2%, P 0.0001) and readmission specifically due to NVUGIB (3.5% vs. 3%, P 0.0078) within 30 days (Table 1).



Discussion: Our analysis showed that prosthetic valve is independently associated with lower mortality from NVUGIB. This indicates that bleeding associated with artificial valves is more likely related to anticoagulation, an etiology that can be reversed by stopping the anticoagulation. The higher readmission rate in the artificial valve group is possibly related to the need for resuming anticoagulation and the potential for re-bleeding as a result. This highlights the importance of carefully selecting antithrombotics and anticoagulants with a lower risk of GI bleeding when discharging patients with NVUGIB.



Disclosures:


Khaled Elfert, MD¹, Mahmoud Khalil, MD², Mohamed Ahmed, MD³, Angelina Dhani Mohamed, MD¹, Mouhand FH. Mohamed, MD⁴, Azizullah Beran, MD⁵, Fouad Jaber, MD⁶, Islam Mohamed, MD⁶, Manasik Abdu, MD⁷, Hadi Mirhedayati Roudsari, MD¹. P2041 - Nonvariceal Upper Gastrointestinal Bleeding in Patients with Prosthetic Valve: Insights from the National Readmission Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.