Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding

Abstract

Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.

Management of acute upper gastrointestinal bleeding

“…A recent multicenter observational study of 619 patients requiring endoscopic therapy for upper gastrointestinal bleeding reported that 44% were taking an antithrombotic drug at presentation, with 25% taking more than one. 41 Although these drugs are a recognized risk factor for upper gastrointestinal bleeding, 42 43 no clear evidence indicates that their use worsens outcomes after the bleed. 41 44 The 2016 US guideline on management of antithrombotic agents for patients undergoing endoscopy suggests that platelet transfusion is an option for life threatening or serious bleeding in patients taking antiplatelet agents.…”

Endoscopic Therapy for Upper GI Bleeding on Antithrombotics – A Safe Option or Do Questions Remain?

“…There was no difference in blood transfusion requirements between groups. Importantly and unexpectedly, Dunne et al 7 found that patients on antithrombotics had a significantly lower risk of all-cause mortality, driven by a lower risk of bleeding-related mortality (1% vs 6%).…”

“…This issue of Clinical Gastroenterology and Hepatology includes a timely study by Dunne et al 7 The investigators conducted a subgroup analysis from a previously published, multicenter, international study investigating the utility of clinical prediction tools in UGIB. 8 In this current study, Dunne et al 7 evaluated the outcomes of patients on antithrombotic medications (including aspirin, thienopyridines, and anticoagulants) who required endoscopic therapy in the original cohort. Their aims were to determine whether antithrombotic use at the time of UGIB was associated with 30-day all-cause and bleedingrelated mortality, rebleeding within 7 days, need for surgery or interventional radiology, and length of hospital stay.…”

“…Unsurprisingly, variceal bleeding also was associated independently with 30-day mortality. Although Dunne et al 7 adjusted for variceal bleeding in the regression analysis, and attempted to account for differences by using interaction terms as well as performing a sensitivity analysis excluding patients with cirrhosis, it remains possible that the higher bleeding-related mortality in the nonantithrombotic group may be partially explained by these high-risk patients with variceal bleeding.…”

Issue Highlights

“…A lthough anti-thrombotic agents are a known risk factor for upper gastrointestinal (GI) bleeding, their impact on patient outcomes is unclear. In this issue of Clinical Gastroenterology and Hepatology, Dunne and colleagues 1 reported results from a multicenter, multi-national prospective cohort study to assess the effect of anti-thrombotic agents on outcomes in patients with high-risk upper GI bleeding. The authors evaluated 568 patients with acute upper GI bleeding who underwent endoscopy between March 2014 and March 2015, of whom 44% used antithrombotic agents.…”