Patients With Upper GI Bleeding on Antithrombotic Drugs Have Less Need for Endoscopic Therapy
By Shazia Qureshi
AMSTERDAM, the Netherlands -- October 15, 2020 -- Patients who present with upper gastrointestinal (GI) bleeding and who are already taking antithrombotic agents may not need endoscopic therapy, according to a study presented at the 2020 United European Gastroenterology Week (UEGW) Virtual Congress.
Rita Jiménez-Rosales, MD, University Hospital Virgen de las Nieves, Granada, Spain, noted that while the use of antithrombotics is a recognised risk factor for upper GI bleeding, previous studies have shown conflicting results as to whether or not antithrombotic use leads to more GI bleeding or the need for endoscopic therapy.
For the current study, the researchers analysed data from 698 consecutive patients with upper GI bleeding who underwent upper GI endoscopy at their hospital between 2013 and 2019. Patients with variceal as well as non-variceal bleeding were included. Of the patients, 258 (37%) were on antithrombotics at the time they presented to the hospital due to upper GI symptoms, of which 62.4% were receiving antiplatelet therapy and 44.6% anticoagulants.
Of the patients on antithrombotics, 25.2% had active bleeding on endoscopy compared with 33.2% of patients in the non-antithrombotic group (P = .027). The need for endoscopic therapy was 33.3% versus 43.6%, respectively (P = .007). Patients in the antithrombotic group were also less likely to have a variceal aetiology of their upper GI bleeding (9.3% vs 22.5%; P
No differences were found between the groups in terms of the length of hospital stay or in-hospital mortality rates and 6-month mortality rates. Both groups also had similar outcomes in terms of non-variceal aetiology of the upper GI bleeding, whether re-bleeding occurred, the need for interventional radiology or surgery, blood transfusions required, and 6-month rates of haemorrhagic events.
Patients taking antithrombotics older (72 vs 60 years; P PP = .026), and were more likely to experience cardiovascular events in the following 6 months (26.1% vs 14.6%; P = .002). In addition, patients on antithrombotics had higher scores on the American Society of Anesthesiologists physical status classification (3.05 vs 2.49; PPP = .001).
Regression analyses found that the independent predictors for the need for endoscopic therapy included active bleeding (odds ratio [OR] = 15.56; PP = .004), and Glasgow-Blatchford score (OR = 1.10; P = .026).
[Presentation title: Patients With Upper Gastrointestinal Bleeding and Previous Use of Antithrombotic Drugs Have Less Need for Endoscopic Therapy. Abstract P0039]