Key result
Prior antithrombotic therapy is not associated with increased in-hospital mortality in upper GI bleeding.
Why the study?
Although antithrombotics are known to increase gastrointestinal bleeding risk, data regarding their influence on patient outcomes remain scarce.
Does prior antithrombotic therapy increase in-hospital or 6-month mortality in patients presenting with upper gastrointestinal bleeding?
Cohort (n=333)
Yes
Does prior antithrombotic therapy increase in-hospital or 6-month mortality in patients presenting with upper gastrointestinal bleeding?
Odds Ratio: 2 (95% CI 0.8–5.1)
Absolute Event Rate: 14.5% vs 10.6%
p-value: p=0.1
Prior antithrombotic therapy does not worsen in-hospital mortality in patients with acute upper gastrointestinal bleeding, and prompt re-initiation appears safe and beneficial for high-risk cardiovascular patients.
May support resuming antithrombotics after upper GI bleed without excess in-hospital mortality; observational data leaves optimal timing open for RCTs.
The association between antithrombotics (ATs) and the risk of gastrointestinal bleeding is well known; however, data regarding the influence of ATs on outcomes are scarce. The goals of this study are: (i) to assess the impact of prior AT therapy on in-hospital and 6-month outcomes and (ii) to determine the re-initiation rate of the ATs after a bleeding event. All patients with upper gastrointestinal bleeding (UGB) who underwent urgent gastroscopy in three centres from 1 January 2019 to 31 December 2019 were retrospectively analysed. Propensity score matching (PSM) was used. Among 333 patients [60% males, mean age 69.2 (±17.3) years], 44% were receiving ATs. In multivariate logistic regression, no association between AT treatment and worse in-hospital outcomes was observed. Development of haemorrhagic shock led to worse survival [odds ratio (OR) 4.4, 95% confidence interval (CI) 1.9–10.2, P < 0.001; after PSM: OR 5.3, 95% CI 1.8–15.7, P = 0.003]. During 6-months follow-up, higher age (OR 1.0, 95% CI 1.0–1.1, P = 0.002), higher comorbidity (OR 1.4, 95% CI 1.2–1.7, P < 0.001), a history of cancer (OR 3.6, 95% CI 1.6–8.1, P < 0.001) and a history of liver cirrhosis (OR 2.2, 95% CI 1.0–4.4, P = 0.029) were associated with higher mortality. After a bleeding episode, ATs were adequately re-initiated in 73.8%. Previous AT therapy does not worsen in-hospital outcomes in after UGB. Development of haemorrhagic shock predicted poor prognosis. Higher 6-month mortality was observed in older patients, patients with more comorbidities, with liver cirrhosis and cancer.
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Hozman et al. (2023) conducted a cohort in Upper gastrointestinal bleeding (UGB) (n=333). Prior antithrombotic therapy vs. No prior antithrombotic therapy was evaluated on In-hospital mortality (OR 2.0, 95% CI 0.8-5.1, p=0.1). Previous antithrombotic therapy was not associated with a significantly higher risk of in-hospital mortality (OR 2.0, 95% CI 0.8-5.1, p=0.1) in patients with acute upper gastrointestinal bleeding.
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