Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case–control study

Kawasaki, Keisuke; Nakamura, Shotaro; Kurahara, Koichi; Nagasue, Tomohiro; Yanai, Shunichi; Harada, Akira; Yaita, Hiroki; Fuchigami, Takeshi; Matsumoto, Takayuki

doi:10.1080/00365521.2017.1328989

Cited by 5 publications

(7 citation statements)

References 29 publications

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“…[4][5][6][7] Peptic ulcers are roughly divided into gastric ulcers and duodenal ulcers (DUs) by their anatomic location, and bleeding DUs are frequently reported to be associated with worse outcomes. [9][10][11] Furthermore, DUs can originate from two anatomically subdivided areas: "the bulb" and "the post-bulbar area." 12 Although bleeding from post-bulbar DUs (PBDUs) can become a source of UGIB, the whole picture of the disease is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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Background Although post‐bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). Methods Data on duodenal ulcers with evidence of endoscopically‐active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in‐hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. Results Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically‐confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in‐hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in‐hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. Conclusion This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.

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Section: Introductionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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“…Thus, more patients in the antithrombotic group suffered more severe illness and required endoscopic hemostasis combining with interventional therapy to stop bleeding and reduce the mortality rate. And study showed that rebleeding rate in the antithrombotic group is significantly higher than that in the control group (13.9% versus 5.8%, P = 0:02) than in the controls [9]. Tracheal intubation and ventilator support can maintain an open respiratory tract and prevent hypoxemia and aspiration caused by gastrointestinal bleeding, particularly in patients with acute upper gastrointestinal bleeding after cardiac surgery or those taking antithrombotic agents.…”

Section: Discussionmentioning

confidence: 90%

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

Gao

Xue

Zhang

2019

Gastroenterology Research and Practice

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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.

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“…In terms of prognosis and application of antithrombotic drugs (Table 2), we found that elderly patients had a longer hospital stay, a higher proportion of patients with a history of antiplatelet drugs, and a higher proportion of patients who used anticoagulants during hospitalization. The median time for elderly patients to use antiplatelet drugs after admission was 10 [4, 14] days, and the median time for using anticoagulant drugs was 6 [3,13] days. The median time for young patients to use antiplatelet drugs after admission was 8 [3,13] days, and the median time for using anticoagulant drugs was 8 [4,11] days.…”

Section: Resultsmentioning

confidence: 99%

Application of Antithrombotic Drugs in Different Age-Group Patients with Upper Gastrointestinal Bleeding

Peng,

Zhai

2024

Gastroenterology Research and Practice

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Objective. This study aimed at exploring the safety and timing of antithrombotic drugs in different age-group patients with UGIB. Methods. An observational study retrospectively based on the single-center database with 713 patients with UGIB. Result. Among the 713 patients, 62.13% were elderly patients (aged>60 years) and the mortality was 2.9%. In elderly patients with UGIB, we found that previous medication history, resumption of medication, and time of resumption did not affect the in-hospital mortality. The resumption of anticoagulants increased the risk of rebleeding. The independent risk factors of mortality were CHF, cirrhosis, creatine kinase, and albumin. The independent risk factors of rebleeding were the application of anticoagulants during hospitalization, variceal bleeding, black stool, red blood cells (lab), platelets (lab), and heart rate. Conclusions. In UGIB patients, a history of antiplatelet or antithrombotic drugs and the use of antiplatelet drugs after UGIB did not affect the patient’s prognosis. In elderly UGIB patients, although antithrombotic drugs did not increase the risk of death, the increased risk of rebleeding after resumption of use deserved careful treatment. It was safe to recover anticoagulant drugs as soon as possible in young UGIB patients.

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Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case–control study

Abstract: Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithrombotic medications can be accepted for bleeding gastroduodenal ulcer.

Cited by 5 publications

References 29 publications

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

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

Application of Antithrombotic Drugs in Different Age-Group Patients with Upper Gastrointestinal Bleeding

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