Previous antithrombotic therapy does not have an impact on the in-hospital mortality of patients with upper gastrointestinal bleeding
European Heart Journal(2022)
Abstract
Abstract Background The association between antithrombotic therapy due to concomitant cardiovascular disorders and the risk of gastrointestinal bleeding is well known; however, data regarding the influence of antithrombotics on outcomes and further management after a bleeding episode are scarce. Purpose This study was conducted to assess the impact of concomitant antithrombotic therapy and other variables on in-hospital and 6-month outcomes and to determine the re-initiation rate of the antithrombotic treatment after a bleeding event. Methods We retrospectively analysed all patients with upper gastrointestinal bleeding (UGB) who underwent urgent gastroscopy in 3 centres from 1 January 2019 to 31 December 2019. Demographic and medical data were collected from the electronic hospital database system. Results Among 333 patients (60% males, mean age 69±16 years), 44% were receiving antithrombotics. The in-hospital mortality rate was 12%, and the 6-months was 32%. In logistic regression we observed no association between antithrombotics and worse in-hospital outcomes. Haemorrhagic shock (OR 5.7, 95% CI 2.7 to 12.2; p<0.001), as well as a history of cancer (OR 2.7, 95% CI 1.1 to 6.9; p=0.03) and higher comorbidity (mean Charlson comorbidity index 5.6 vs. 6.9, OR 1.3, 95% CI 1.1 to 1.6; p=0.005) led to higher in-hospital mortality (tab. 1). In terms of 6-months outcomes, higher age (OR 1.03, 95% CI 1.00 to 1.05; p=0.02), higher comorbidity (OR 1.4, 95% CI 1.2 to 1.6; p<0.001), a history of cancer (OR 4.5, 95% CI 2.0 to 10.1; p<0.001) and a history of liver cirrhosis (OR 2.3, 95% CI 1.2 to 4.6; p=0.02) were associated with higher mortality. Other tested variables such as ischemic heart disease, heart failure or diabetes did not influence 6-month outcomes at statistically significant level (tab. 2). After a bleeding episode, antithrombotic treatment in patients with lasting indication from cardiovascular reasons was re-initiated in 81% of cases. One patient with atrial fibrillation was referred for a left atrial appendage closure. Conclusions Based on our observations, previous antithrombotic therapy does not worsen in-hospital outcomes in patients with UGB. Development of haemorrhagic shock during hospitalization predicted poor prognosis. Higher 6-month mortality was observed in older patients and patients with a history of liver cirrhosis. A history of cancer and higher comorbidity negatively affected the short- as well as long-term prognosis. Funding Acknowledgement Type of funding sources: None.
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Key words
previous antithrombotic therapy,upper gastrointestinal bleeding,patients,in-hospital
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