Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

Abstract

Background: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/ or anticoagulants and represents a clinical challenge in patients undergoing these therapies.Aim: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes.Methods: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012. The outcomes were compared between patients exposed and not exposed to antithrombotics.Results: Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years) were included, of which 43% received antithrombotics. Most patients had comorbidities. Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases. The 30-day mortality rate was 7.7% (n = 42), and 36% were bleeding-related. The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment. There were no significant differences between the exposed and non-exposed groups in most outcomes. Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL) and higher international normalized ratio (1.63 ± 1.13) were associated significantly with mortality in a univariate analysis.Conclusions: Adverse outcomes were not associated with antithrombotic use. The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.

Characteristics and clinical outcomes of patients with acute gastrointestinal bleeding related to anticoagulant or antiplatelet therapy: a retrospective study

“…Interestingly, the mortality was slightly lower in the AC/APT group (8.3%) than in nonexposed group (10.3%). Similar results were observed in other studies ( 3 , 20 ). We found no significant difference in overall mortality according to sex or type of therapy.…”

“…Similar to the present study, other authors found that the most prevalent bleeding lesion was peptic ulcer, and that the most common bleeding-related agent was ASA ( 1 , 3 , 16 , 20 , 21 ). In our study, the most frequent bleeding site was gastric ulcer, confirming the decrease in duodenal ulcer bleedings over the years ( 22 ).…”

“…These patients also had a high mean age (74.9 ± 10.7 years). Other studies also observed a high mean age (67.7-77.1 years) in the APT or AC group ( 1 , 3 , 6 , 19 , 20 ).…”

“…In our cohort, the most common comorbidities were AH (62%), ischemic heart disease (45%), heart failure, (34%), AF (32%), and DM (23%). Certain upper GIB studies in patients receiving APT/AC treatment also reported a high prevalence of AH and cardiovascular diseases, but also of DM ( 1 , 16 , 20 ). In the study by Jorgensen et al, DM and AF were identified as risk factors for a fatal outcome in univariate analysis, but in multivariate analysis none of the variables remained significant ( 1 ).…”

“…In the study by Jorgensen et al, DM and AF were identified as risk factors for a fatal outcome in univariate analysis, but in multivariate analysis none of the variables remained significant ( 1 ). In a study by Sampaio et al, the risk of 30-day mortality was five times higher in patients with one or more comorbidities, while metastatic disease increased the risk 12-fold ( 20 ).…”