Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding

Abstract

Background/Aims:There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding.Materials and Methods:The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients.Results:In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038).Conclusıon:Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.

Characteristics and clinical outcomes of patients with acute gastrointestinal bleeding related to anticoagulant or antiplatelet therapy: a retrospective study

“…Similar to the present study, other authors found that the most prevalent bleeding lesion was peptic ulcer, and that the most common bleeding-related agent was ASA ( 1 , 3 , 16 , 20 , 21 ). In our study, the most frequent bleeding site was gastric ulcer, confirming the decrease in duodenal ulcer bleedings over the years ( 22 ).…”

“…Approximately 26% of patients hospitalized for upper GIB were treated with AC or APT therapy, and this percentage reached 50.7%-59.3% when patients treated with NSAR were taken into account ( 1 , 6 , 16 , 17 ). Oakland et al ( 18 ) demonstrated a high exposure to AC or APT therapy (36.3%) in patients admitted for lower GIB.…”

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

“…These findings are in agreement with T. Solakoglu et al, who have put forth the use of longer duration PPI infusion in the exposed group as a possible explanation. It was recognized that an appropriate duration of this therapy was essential to allow for the healing of the gastrointestinal mucosa and to prevent recurrence in high-risk patients (15). Another possible explanation could be the greater prophylactic use of PPIs in the exposed group (21.5% vs 20.3%); however, a lack of statistical significance makes this a less likely hypothesis.…”

“…First, it is recognized that maintenance of this therapy increases the risk of recurrence or the continuation of bleeding; however, these patients have an increased thromboembolic risk due to the underlying disease. Temporary discontinuation of antithrombotic therapy is often necessary to control the bleeding and to prevent an early relapse (15). According to current evidence, the use of APAs as a secondary prophylaxis should be reinitiated as soon as possible after the episode of NVUGB (28), even if this would increase the rebleeding rate as it can potentially reduce overall mortality (29) and its discontinuation increases the risk of death and acute cardiovascular events by around sevenfold (30).…”

Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study

“…Timely determination of the nature of bleeding lesions during EG by a biopsy provides strong support for clinicians to choose the correct clinical path and to avoid the mistake of treatment decision-making [ 3 ]. For malignant lesions, timely and effective surgical operations can avoid the expense of excessive drug treatment and thus save hospitalization costs [ 23 , 24 ]. However, in univariate analysis before matching, there was no significant difference in the hospitalization costs of patients undergoing a biopsy during EG with Forrest I ANVUGIB combined with SMGU and those without.…”