Article ; Online: Improved Survival for Patients With Acute Upper Gastrointestinal Bleeding While on Antithrombotic Therapy: A Multicenter Prospective Cohort Study.
Journal of clinical gastroenterology
2023 Volume 57, Issue 3, Page(s) 278–284
Abstract: Goals: Aim of the study was to determine if patients with acute upper gastrointestinal bleeding (AUGIB) while on antithrombotic agents (ATs) are at higher risk for worse outcomes.: Background: ATs are risk factors of AUGIB, but their impact on ... ...
| Abstract | Goals: Aim of the study was to determine if patients with acute upper gastrointestinal bleeding (AUGIB) while on antithrombotic agents (ATs) are at higher risk for worse outcomes. Background: ATs are risk factors of AUGIB, but their impact on clinical outcomes is uncertain. Study: Patients with AUGIB (nonvariceal, NV-AUGIB or variceal, V-AUGIB) in 50 Italian hospitals were prospectively enrolled from January 1, 2014 to December 31, 2015. Clinical data, laboratory tests, comorbidities, prognostic scores, received therapies, and outcomes (death, rebleeding, surgery/radiology, transfusions, length of hospitalization) were analyzed. Results: A total of 3324 patients (2764 NV-AUGIB, 83.2% and 560 V-AUGIB, 16.8%) were enrolled, 1399 (42.1%) on ATs. Patients taking ATs were older (75.4 vs. 62.8 y, P <0.001), had higher American Society of Anesthesiologists (ASA), Rockall and Glasgow-Blatchford scores ( P <0.001). At multivariate analysis considering comorbidities, ATs use resulted an independent protective factor against death [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.45-0.87, P =0.006]. Rebleeding (5.5% vs. 5.8%, P =0.71) and need for salvage surgery/radiology (4.2% vs. 4.8%, P =0.41) were similar in the 2 groups. Considering specific ATs, low-dose aspirin was the most powerful factor lowering the death risk (OR: 0.51, 95% CI: 0.33-0.81, P =0.004). While the generic use of AT therapy did not emerge as a statistically significant independent protective factor considering separately NV-AUGIB (OR: 0.80, 95% CI: 0.56-1.13, P =0.21) and V-AUGIB (OR: 0.40, 95% CI: 0.15-1.07, P =0.068), the protective effect of low-dose aspirin was confirmed for NV-AUGIB (OR: 0.62, 95% CI: 0.41-0.94, P =0.025). Conclusions: ATs use is an independent protective factor against death in AUGIB. The protective effect is mainly derived from low-dose aspirin. |
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| MeSH term(s) | Humans ; Fibrinolytic Agents/adverse effects ; Prospective Studies ; Gastrointestinal Hemorrhage/etiology ; Risk Factors ; Aspirin/adverse effects ; Acute Disease |
| Chemical Substances | Fibrinolytic Agents ; Aspirin (R16CO5Y76E) |
| Language | English |
| Publishing date | 2023-03-01 |
| Publishing country | United States |
| Document type | Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 448460-5 |
| ISSN | 1539-2031 ; 0192-0790 |
| ISSN (online) | 1539-2031 |
| ISSN | 0192-0790 |
| DOI | 10.1097/MCG.0000000000001674 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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