Gastrointestinal Hemorrhage after Acute Ischemic Stroke and Its Risk Factors in Asians

Abstract

Background: The aim of this study was to examine the frequency and risk factors of gastrointestinal (GI) hemorrhage in acute ischemic stroke patients in Taiwan. Method: 920 patients admitted for acute ischemic stroke from January 2001 to October 2005 were included in the study. We reviewed the available medical records for any episode of GI hemorrhage, possible precipitating factors and administration of ulcer prophylaxis. Results: Seventy-two patients (7.8%) experienced GI hemorrhage; these patients were of an older age (74.7 vs. 69.0 years, p < 0.001), had a longer acute ward stay (30.4 vs. 12.9 days, p < 0.001) and higher mortality rate (odds ratio 9.61, CI 4.53–20.42) than patients without GI hemorrhage. In multivariate logistic regression analysis, the important risk factors of GI hemorrhage included sepsis, previous history of GI hemorrhage, severe stroke, renal insufficiency and abnormal liver function. Of the 779 patients who had a 0–1 risk factor, 26 (3.3%) experienced GI hemorrhage; of the 27 patients with more than 2 risk factors, 17 (63%) suffered GI hemorrhage. Conclusion: This study of Asians revealed a higher frequency of GI hemorrhage after acute ischemic stroke than that reported in previous studies, and the frequency of GI hemorrhage was positively correlated with the number of risk factors present. We suggest that identifying stroke patients with a high risk of hemorrhage may allow clinicians to set up ulcer prophylactic protocols for the patients most likely to benefit, especially in an Asian population.

Gastrointestinal Bleeding After Intracerebral Hemorrhage: A Retrospective Review of 808 Cases

“…3,9,11,12 Although ischemic stroke is included or involved in most studies, only 1 small-scale study suggested that the incidence of GI bleeding after ICH was about 30%, 3 which is similar to our present findings. However, because 63.4% of the patients in our study were prescribed SUP, the natural incidence of GI bleeding after ICH is still not clear.…”

“…13 Small-sample endoscopy data involving stroke patients showed that most patients who developed GI bleeding after stroke manifested esophageal ulcers, erosive gastritis or gastric ulcer. 11,12 In the present study, the exact cause of bleeding could not be ascertained in patients with GI bleeding, as their conditions were too serious to allow for endoscopy.…”

Association between renal dysfunction and 3-year mortality in patients with acute first-ever ischemic stroke

“…UTIs are associated with poorer neurological outcomes and longer hospital stays after stroke [44]. The prevalence of GI hemorrhage after acute stroke ranged from 0.5% to 30% [45], and was higher among ischemic stroke patients with CKD [46]. We also found that reduced eGFR was associated with poor functional outcomes upon discharge, which was similar to previous studies [12,24,30].…”

Gastrointestinal Bleeding in Acute Ischemic Stroke: Recent Trends from the Fukuoka Stroke Registry

“…Gastrointestinal (GI) bleeding is a well-known complication that may occur during the acute phase of stroke [1,2,3,4,5,6] with an incidence of 0.1-8.0%, depending on the population studied. Previous studies have identified various factors associated with GI bleeding after acute ischemic stroke [1,3,4,6].…”