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Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

2016; Arán Ediciones; Volume: 108; Linguagem: Inglês

10.17235/reed.2016.4424/2016

2340-4167

Elvira Teles Sampaio, Luís Maia, Paulo Salgueiro, Ricardo Marcos‐Pinto, Mário Dinis‐Ribeiro, Isabel Pedroto,

Platelet Disorders and Treatments

Background: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/ or anticoagulants and represents a clinical challenge in patients undergoing these therapies.Aim: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes.Methods: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012.The outcomes were compared between patients exposed and not exposed to antithrombotics.Results: Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years) were included, of which 43% received antithrombotics.Most patients had comorbidities.Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases.The 30-day mortality rate was 7.7% (n = 42), and 36% were bleeding-related.The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment.There were no significant differences between the exposed and non-exposed groups in most outcomes.Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL) and higher international normalized ratio (1.63 ± 1.13) were associated significantly with mortality in a univariate analysis.Conclusions: Adverse outcomes were not associated with antithrombotic use.The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.