title: High Rates of Bleeding Complications among Hospitalized Patients with Hereditary Hemorrhagic Telangiectasia in the United States.
abstract: There is sparse published literature on the causes and outcomes of hospitalization of patients with hereditary hemorrhagic telangiectasia (HHT).
  
  
  
  To evaluate rates of various complications, comorbidities, and in-hospital outcomes of patients with HHT using a large, multihospital inpatient database.
  
  
  
  We identified patients with HHT in the U.S. Nationwide Inpatient Sample between 2000 and 2012. Rates of hemorrhagic, neurological, hepatic, and cardiopulmonary complications among hospitalized patients with HHT were evaluated. We also studied procedure use rates for blood transfusion, endoscopy, and epistaxis treatment. Hospitalization outcomes, including in-hospital mortality, discharge status, charges, and length of stay, were evaluated.
  
  
  
  We identified 10,293 patients with HHT. The mean age of the HHT population was 60.7 years. Sixty percent of patients were female. More than 75% of HHT hospitalizations occurred in those older than 50 years of age. Patients with HHT had high rates of bleeding-related complications, including anemia (53.3%), epistaxis (16.2%), and gastrointestinal bleeding (10.8%). Overall, bleeding complications accounted for 62.7% of HHT-related complications. Thirty-eight percent of hospitalized patients with HHT received one or more transfusions of a blood product. Cardiopulmonary complications were present in 41.0% of the cases. Congestive heart failure was the second most common individual complication among patients with HHT, affecting 19.9% of patients. The in-hospital mortality rate was 1.9%.
  
  
  
  In this large, nationwide study, we found that nearly two-thirds of patients hospitalized with HHT experienced a bleeding-related complication. Nearly 40% of hospitalized patients with HHT required transfusion of blood products. Cardiopulmonary complications, including congestive heart failure, were the second most common complication. The high burden of bleeding-related complications points to a significant unmet clinical need for these patients.
authors.affiliation: 1 Department of Radiology.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: 1 Department of Radiology.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Wood
authors.affiliation: 2 Department of Neurosurgery.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: 1 Department of Radiology.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: 1 Department of Radiology.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Misra
authors.affiliation: 1 Department of Radiology.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: 3 Division of Gastroenterology.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kamath
authors.affiliation: 4 Division of Hematology, and.
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Pruthi
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Krowka
authors.affiliation: 6 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Swanson
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Iyer
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D016208:Databases, Factual; D004844:Epistaxis / Q000453:epidemiology*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: anemia; bleeding; epidemiology; hemorrhage; hereditary hemorrhagic telangiectasia