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Transfusion strategy in acute non-variceal upper gastrointestinal bleeding among high-risk cardiac patients: a 3-year prospective monocentric study from Marrakech, Morocco
Poster Abstract

Aims

Patients with ischemic heart disease (IHD) are at increased risk of upper gastrointestinal bleeding (UGIB), mainly due to antiplatelet therapy. International guidelines recommend a restrictive transfusion strategy for most UGIB patients, but suggest considering a more liberal threshold in high-risk cardiac patients, who may require higher hemoglobin levels to maintain adequate myocardial oxygen supply.

Aim

To compare restrictive versus liberal transfusion strategies in high-risk cardiac patients admitted for acute non-variceal UGIB in a Moroccan tertiary center.

Methods

A prospective randomized monocentric study was conducted at CHU Mohammed VI, Marrakech, between January 2022 and January 2025.A total of 76 high-risk cardiac patients with acute non-variceal UGIB were included.High-risk cardiac status was defined briefly as:a history of myocardial infarction, coronary stents, coronary bypass surgery, ongoing/recent ischemia, reduced left ventricular ejection fraction (<40%), significant arrhythmias, or dual antiplatelet therapy.

Patients were randomized into:

  • Restrictive strategy: transfusion when Hb ≤ 8 g/dL

  • Liberal strategy: transfusion when Hb ≤ 10 g/dL, in accordance with recommendations for cardiac high-risk patients

The primary endpoint was 30-day rebleeding. Secondary outcomes included mortality, cardiovascular events, and hospital stay duration.

Results

Of the 76 included patients, 38 received restrictive transfusion and 38 received liberal transfusion. Baseline characteristics were comparable between groups.

30-day rebleeding:

  • Restrictive: 18.4%

  • Liberal: 13.2%(p > 0.05, not significant)

30-day all-cause mortality: no significant difference.

Hospital stay: slightly shorter in the liberal group (mean 6.8 vs 7.4 days).

Major cardiovascular events:

  • Restrictive: 15.8%

  • Liberal: 7.9%Liberal transfusion was associated with fewer heart-failure episodes and acute coronary syndromes.

Conclusions

In this 3-year Moroccan monocentric cohort of high-risk cardiac patients with acute non-variceal UGIB, a liberal transfusion strategy (Hb ≤ 10 g/dL) did not increase rebleeding or mortality.It was associated with:

  • fewer major cardiovascular events,

  • and a slightly shorter hospital stay.

These findings support the use of a more liberal transfusion threshold in high-risk cardiac patients, in line with international recommendations.