Characteristics of Hemorrhagic Peptic Ulcers in Patients Receiving Antithrombotic/Nonsteroidal Antiinflammatory Drug Therapy

Abstract

Background/AimsAntithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated.MethodsWe investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were categorized as the antithrombotic therapy (AT) group (n=213). The patients who were not treated with antithrombotics/NSAIDs were categorized as the control (C) group (n=263). The clinical characteristics were compared between the groups.ResultsThe patients in the AT group were significantly older than those in the C group (p<0.0001). The hemoglobin levels before/without transfusion were significantly lower in the AT group (8.24±2.41 g/dL) than in the C group (9.44±2.95 g/dL) (p<0.0001). After adjusting for age, the difference in the hemoglobin levels between the two groups remained significant (p=0.0334). The transfusion rates were significantly higher in the AT group than in the C group (p=0.0002). However, the outcome of endoscopic hemostasis was similar in the AT and C groups.ConclusionsPatients with hemorrhagic peptic ulcers receiving antithrombotic/NSAID therapies were exposed to a greater risk of severe bleeding that required transfusion but were still treatable by endoscopy.

Characteristics of patients with non‐variceal upper gastrointestinal bleeding taking antithrombotic agents

“…Some studies have reported that patients with peptic ulcers treated with antithrombotics are at great risk of bleeding severely enough to require transfusion . In the present study, mean hemoglobin levels on admission were significantly lower in group A than in group NA; however, the transfusion volumes were significantly lower in group A than in group NA.…”

“…2,3 Antithrombotic agents, including low-dose aspirin, antiplatelet drugs, and anticoagulants, are considered to increase the risk of UGIB. 4 Although an increased incidence of UGIB during administration of antithrombotic therapies has been extensively described, 5 the precise characteristics of UGIB associated with antithrombotic therapies are less understood than those of UGIB unassociated with antithrombotic therapies. Additionally, many endoscopists have had more opportunities to carry out diagnostic and therapeutic endoscopy on patients receiving antithrombotic agents.…”

Time Trends of the Impact of <b><i>Helicobacter pylori</i></b> Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

“…We suggest that this result may be caused by the increased concomitant use of antithrombotic agents because of the increase in elderly population [1]. Recently, dual antiplatelet therapies with combinations of LDA and another antiplatelet have become a standard therapy in patients with coronary artery diseases treated with drug-eluting stents [19]. Such combined antithrombotic therapies further increase the threat of PUB compared with antiplatelet monotherapies [14].…”

“…An increasing number of patients are being given antithrombotic agents for vascular protection [19]. A recent meta-analysis showed that LDA increased the risk for gastrointestinal bleeding and the risk increased with accompanying use of clopidogrel and anticoagulant therapies [20].…”

Management of antithrombotic agents during emergency endoscopy for upper gastrointestinal bleeding: A propensity score matching analysis

“…10 An increased incidence of UGIB during the administration of antithrombotic therapies has been extensively described, providing endoscopists with more instances to perform emergency endoscopy procedures on patients who are taking antithrombotic agents. 13,14 Emergency endoscopic hemostasis has proven bene cial in all cases of UGIB. [15][16][17][18] In terms of promptness, urgent endoscopy performed within 24 hours of UGIB has been shown to diminish the likelihood of mortality and surgical intervention in high-risk UGIB cases.…”