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identify patients with CSPH. A training set of 69 patients was used, and results were validated using an independent series of 128 patients with compensated cirrhosis from another centre. Results: The combination of Pl count and LSM measurement was more accurate for identifying CSPH than either marker alone (training cohort AUROC: 0.87 [0.77-0.94] vs. 0.77 [0.66- 0.86] and 0.78 [0.66 - 0.87] for platelets and LSM). The optimal risk score was 0.11 (Sens = 0.88, Spec = 0.77, PPV = 0.33, NPV = 0.98, accuracy = 78%). Results in the validation cohort confirmed the discriminatory power of this model (AUROC: 0.76 [0.68-0.83]). We then tested clinically relevant cut-offs to improve the NPV for CSPH. The NPV for the combination of Pl ≥ 100 and LSM < 25 kPa was 100% in both the training cohort and validation cohort (Table 1). 82 (42%) of patients overall met this criteria. Conclusion: The combination of LSM < 25 kPa and Pl ≥ 100 can be used to identify patients with compensated cirrhosis who do not have CSPH. Our study suggests that patients meeting these criteria do not require endoscopic screening for CSPH, but could be followed with annual LSM and full blood count. Mo1010 Severity of Bleeding Complications in Cirrhotic Patients Compared to Non- Cirrhotic Patients Treated for Acute Myocardial Infarction Sean Rudnick, Benjamin Shepple, Ellen Keeley, Zachary Henry, Curtis K. Argo, Neeral Shah Background: Little is known regarding the incidence, predictors, and severity of bleeding in cirrhotic patients treated for acute myocardial infarction (MI). Methods: Using the Clinical data repository we identified patients age ≥ 18 years from 1/1/2011 to 12/31/12 who were admitted with an International Classification of Diseases-9 (ICD-9) code for cirrhosis and an ICD-9 code for acute MI. Inclusion required a diagnosis of cirrhosis based on biopsy or clinical, laboratory, and radiological findings. Acute MI was defined by the American Heart Association's 3rd Universal Definition of MI. Thirty one patients met inclusion criteria and 31 non-cirrhotic controls with acute MI were identified and matched to cases on a 1:1 basis based on age, sex, and cardiovascular risk factors including diabetes, known coronary artery disease, and tobacco use. Bleeding events in cases and controls were compared. The Global Use of Strategies to Open Occluded Arteries (GUSTO) bleeding classification was used to define bleeding events as mild (GUSTO 1), moderate (GUSTO 2), and severe/life-threatening (GUSTO 3) based on clinical criteria. Results: Overall, 23% of cirrhotic patients treated for MI had a bleeding event compared to 6.5% of controls. Less than half (45%) of cirrhotic patients underwent coronary angiography. Those who underwent coronary angiography had significantly higher bleeding complications compared to those treated medically (43% vs. 6%, p<0.03), and were more likely to receive aspirin, clopidogrel, and anticoagulation. There was no statistically significant difference between mean platelet count or INR in cirrhotic patients with and without bleeding. In the control group 84% underwent coronary angiography and 2 had mild, GUSTO 1 bleeding events. Vascular access site appeared to affect the risk of bleeding as no patients with radial artery access had a bleeding event, but 3 patients with femoral artery access experienced bleeding. In the cirrhotic group, 6 patients who underwent coronary angiography had a bleeding event, while 1 had a bleeding event even though they did not undergo coronary angiography. No controls developed gastrointestinal bleeding (GIB). Four cirrhotic patients developed GIB, 2 of these also underwent coronary angiography. While nearly one-third of the cirrhotic patients had a history of esophageal varices, only one patient developed a variceal bleed that was successfully managed endoscopi- cally. One cirrhotic patient developed GIB despite not receiving anticoagulation. Conclusions: Bleeding events were more common among cirrhotic patients with MI compared to controls (23% vs. 6.5%) and in those who underwent coronary angiography. The majority of the bleeding events were GUSTO 1-2 and equally distributed between cath-related and GIB. Strategies to reduce the risk of bleeding in cirrhotic patients treated for MI are needed. Severity and Bleeding Site in Patients Treated for Acute Myocardial Infarction S-985 AASLD Abstracts Mo1011 Defining the Factors That Predict the Likelihood of Rebleeding Following Variceal Ligation Molly Disbrow, M Edwyn Harrison, Hugo E. Vargas, Elizabeth J. Carey, Thomas Byrne, Bashar Aqel BACKGROUND: Esophageal varices are a common complication in end stage liver disease, seen in 50% of patients with cirrhosis and up to 85% of patients with Child Class C disease. Bleeding from varices occurs at a yearly rate of 5-15% and endoscopic variceal ligation (EVL) is one of the standard treatment modalities in the management and prophylaxis of variceal hemorrhage. However, EVL itself can result in complications including upper gastrointestinal (GI) bleeding. Currently, there are little data describing the factors associated with early rebleeding following EVL. AIM 1. Evaluate the rate of complications including early upper GI bleeding (within four weeks) of EVL. AIM 2. Describe risk factors that can predict likelihood of early rebleeding following variceal ligation. METHODS: We conducted a retrospective review of the electronic medical records from November 2007 to June 2010 for patients who underwent esophageal variceal ligation for bleeding or prophylaxis of esophageal varices. Data recorded included age, sex, etiology of liver disease, Childs Class, MELD score, history of GI bleeding, if band ligation was urgent/emergent (within 24 hours of GI bleeding), number of EVL sessions per patient, GI bleeding within four weeks of EVL, and death within four weeks of EVL. A predictive model using the generalized estimation equation was used to examine factors predicting early bleeding. The variables with p-value less than or equal to 0.3 were considered and included in the model selection. Backward elimination was applied to select the set of variables associated with early bleeding, and any variable with p-value <0.1 were retained in the model. RESULTS: 156 patients underwent a total of 349 endoscopies for EVL (Table 1). There were 66 (42.6%) women, the mean age of cohort was 58.3 (SD=9.93) years, with 22 (14.7%) Child Class C.). 76 patients (49.4%) had history of prior bleeding, and 36 (23.2%) underwent EVL emergently/urgently (within 24 hours of admission for GI bleeding), the rest of procedures were done for primary prophylaxis. Post banding chest pain was seen in 9 patients (7.7%). Six patients (3.9%) had upper GI bleeding after EVL with mean time to rebleed 11.2 days (SD=11.2). Three patients (1.9%) died within four weeks of EVL. Predictive model analysis found that the MELD score, indication for banding, and use of B-blockers to be significant predictors for early bleeding after EVL (Table 2). CONCLUSIONS: Rebleeding rate after EVL was 3.9% with estimated mortality of 1.9%. MELD score, acute indication for EVL, and use of B-blockers were predictive of early rebleeding. Table 1: Clinical Characteristics and Demographics Table 2: Predictors of Early Rebleeding Mo1012 Characteristics of Cirrhotic Patients With Concomitant Portal Vein Thrombosis and Non-Splanchnic Venous Thromboembolism Jeffrey LaFond, Neil D. Shah, Nicolas M. Intagliata, Patrick G. Northup, Stephen H. Caldwell, Neeral L. Shah Background: It is well known that cirrhotic patients develop both portal vein thrombosis (PVT) and non-splanchnic venous thromboembolism (NSVTE). Studies have shown the prevalence of PVT in patients with cirrhosis is 15-30%. There are no guidelines for the treatment of either PVT or NSVTE in patients with cirrhosis. Also, to our knowledge no one has studied the characteristics of patients with both NSVTE and PVT. We evaluated a cohort of cirrhotic patients with NSVTE to investigate whether there are any characteristics or associations for those with concomitant PVT. Methods: 147 subjects were initially identified via the clinical data repository at a large academic tertiary care medical center by relevant ICD9 codes. The medical record was retrospectively reviewed for the presence of NSVTE on diagnostic imaging and cirrhosis confirmed by either liver biopsy or radiographic evidence in conjunction with the appropriate clinical presentation. 50 patients met the inclusion criteria and were followed for a 6 month period. Records were reviewed from September 2009 to December 2012. Data regarding demographics, cancer history, prior history of NSVTE or PVT, presence of central venous catheter (CVC), history of esophageal varices and related bleeding, and relevant laboratory data were compiled. Patients with NSVTE and PVT were compared to those with NSVTE only. Results: Of the 50 patients, 9 (18%) patients were found to have a PVT. PVT patients were more likely to have a history of esophageal AASLD Abstracts
