Treatment of Acute Nonvariceal Upper Gastrointestinal Bleeding in Chinese Patients on Antithrombotic Therapy

Abstract

Objective. To assess the treatment of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) in Chinese patients on antithrombotic therapy. Methods. The clinical data of patients with ANVUGIB who underwent upper gastrointestinal endoscopy 24 h after bleeding at Beijing Anzhen Hospital, Capital Medical University, from 2016 to 2018, were analyzed retrospectively. The patients were divided into antithrombotic therapy and control groups and into high-risk (Forrest Ia, Ib, IIa, and IIb) and low-risk (Forrest IIc and III) bleeding groups according to the results of endoscopy. Results. In all, 230 patients were enrolled, with 99 cases in the antithrombotic group (antiplatelet therapy 80 patients, anticoagulant therapy 19 patients) and 131 cases in the control group (without antithrombotic therapy). A total of 78 and 21 and 84 and 47 patients were at high- and low- risk for bleeding (P=0.019) in the antithrombotic and control groups, respectively; 12.1% and 4.6% had esophageal bleeding (P=0.047), and 8 and 2 patients received interventional therapy (P=0.021). Overall, 21 patients with hemodynamic instability were treated via endoscopy with anesthesia under tracheal intubation and ventilator support: 20 patients in the antithrombotic group (13 patients within 1 month after coronary intervention, 5 patients within 1 month of cardiac-valve replacement, and 2 patients within 4 years of cardiac-valve replacement) and 1 patient with third-degree atrioventricular block in the control group. Ten patients received interventional therapy: eight and two in the two groups, respectively. Multidisciplinary consultation was conducted to regulate the use of antithrombotic drugs. Conclusion. Compared to the controls, patients in the antithrombotic group had a significantly higher incidence of critical and active bleeding. Patients with hemodynamic instability should be examined and treated via upper gastrointestinal endoscopy under anesthesia with tracheal intubation and ventilator support.

Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study

“…Forrest classification was as follows: Ia spurting bleeding, Ib oozing bleeding, IIa nonbleeding visible vessel, IIb an adherent clot, IIc flat pigmented spot, and III clean base ulcer. The sites of bleeding were classified as the esophagus, stomach, and duodenum according to the gastroscopy results [10]. Some scoring systems have been developed to predict bleeding outcomes for patients with ANVUGIB bleeding.…”

Enteric-Coated Aspirin and the Risk of Gastrointestinal Side Effects: A Systematic Review

“…20,21 Additionally, the degree of this small bowel mucosal injury was greater in elderly patients taking ECA than middle-aged patients. 10 In another case control study, the risk of upper GI complications was similar for both ECA and non-ECA. So, the authors concluded that the coating did not adjust the effect of aspirin.…”

“…The mechanisms by which aspirin causes GI mucosal damage are thought to be by both direct topical injury on the epithelium and mainly, a systemic effect associated to prostaglandin depletion. 9,10 Different research has mentioned the risk factors for aspirin-induced GI complications, such as higher aspirin dose, advanced age, history of peptic ulcer disease, use of combinations of non-steroidal antiinflammatory drugs and concomitant use of drugs such as steroids or anticoagulants. 11,12 There are mechanisms used to diminish aspirinassociated GI injury, like reducing the dose of aspirin 6,13 and use of aspirin with a gastro-protective agents like proton pump inhibitors.…”