Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding

Philip D J Dunne, Stig B Laursen, Loren Laine, Harry R Dalton, Jing H Ngu, Michael Schultz, Adam Rahman, Andrea Anderloni, Iain A Murray, Adrian J Stanley

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Background & Aims: Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. Methods: We performed a prospective study of 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015. We collected data recorded on use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores. We also collected and analyzed data on co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality. Results: Of the 619 patients who required endoscopic therapy, data on use of anti-thrombotic agents was available for 568; 253 of these patients (44%) used anti-thrombotic agents. Compared to patients not taking anti-thrombotic agents, patients treated with anti-thrombotics were older (P <.001), had a higher mean American Society of Anesthesiologists classification score (P <.0001), had a higher mean Rockall score (P <.0001), a higher mean AIMS65 score (P <.0001), and more frequently bled from ulcers (P <.001). There were no differences between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion. All-cause mortality was lower in patients who took anti-thrombotic drugs (11 deaths, 4%) than in patients who did not (37 deaths, 12%) (P =.002); this was due to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1%) than in patients who were not (19 deaths, 6%) (P =.003). Patients taking anti-thrombotic drugs had mean hospital stays of 6.9 days (95% CI, 2–23 days) compared to 7.9 days for non-users of anti-thrombotic agents (95% CI, 2–26 days) (P =.04). Conclusions: Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.

OriginalsprogEngelsk
TidsskriftClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Vol/bind17
Udgave nummer3
Sider (fra-til)440-447.e2
ISSN1542-3565
DOI
StatusUdgivet - 1. feb. 2019

Fingeraftryk

Fibrinolytic Agents
Length of Stay
Interventional Radiology
Pharmaceutical Preparations
Melena
Hematemesis
Coffee
Proxy
North America
Hospital Mortality
Ulcer
Prospective Studies

Bibliografisk note

Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Citer dette

Dunne, Philip D J ; Laursen, Stig B ; Laine, Loren ; Dalton, Harry R ; Ngu, Jing H ; Schultz, Michael ; Rahman, Adam ; Anderloni, Andrea ; Murray, Iain A ; Stanley, Adrian J. / Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding. I: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2019 ; Bind 17, Nr. 3. s. 440-447.e2.
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title = "Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding",
abstract = "Background & Aims: Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. Methods: We performed a prospective study of 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015. We collected data recorded on use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores. We also collected and analyzed data on co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality. Results: Of the 619 patients who required endoscopic therapy, data on use of anti-thrombotic agents was available for 568; 253 of these patients (44{\%}) used anti-thrombotic agents. Compared to patients not taking anti-thrombotic agents, patients treated with anti-thrombotics were older (P <.001), had a higher mean American Society of Anesthesiologists classification score (P <.0001), had a higher mean Rockall score (P <.0001), a higher mean AIMS65 score (P <.0001), and more frequently bled from ulcers (P <.001). There were no differences between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion. All-cause mortality was lower in patients who took anti-thrombotic drugs (11 deaths, 4{\%}) than in patients who did not (37 deaths, 12{\%}) (P =.002); this was due to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1{\%}) than in patients who were not (19 deaths, 6{\%}) (P =.003). Patients taking anti-thrombotic drugs had mean hospital stays of 6.9 days (95{\%} CI, 2–23 days) compared to 7.9 days for non-users of anti-thrombotic agents (95{\%} CI, 2–26 days) (P =.04). Conclusions: Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.",
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author = "Dunne, {Philip D J} and Laursen, {Stig B} and Loren Laine and Dalton, {Harry R} and Ngu, {Jing H} and Michael Schultz and Adam Rahman and Andrea Anderloni and Murray, {Iain A} and Stanley, {Adrian J}",
note = "Copyright {\circledC} 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.",
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language = "English",
volume = "17",
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Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding. / Dunne, Philip D J; Laursen, Stig B; Laine, Loren; Dalton, Harry R; Ngu, Jing H; Schultz, Michael; Rahman, Adam; Anderloni, Andrea; Murray, Iain A; Stanley, Adrian J.

I: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Bind 17, Nr. 3, 01.02.2019, s. 440-447.e2.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding

AU - Dunne, Philip D J

AU - Laursen, Stig B

AU - Laine, Loren

AU - Dalton, Harry R

AU - Ngu, Jing H

AU - Schultz, Michael

AU - Rahman, Adam

AU - Anderloni, Andrea

AU - Murray, Iain A

AU - Stanley, Adrian J

N1 - Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background & Aims: Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. Methods: We performed a prospective study of 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015. We collected data recorded on use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores. We also collected and analyzed data on co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality. Results: Of the 619 patients who required endoscopic therapy, data on use of anti-thrombotic agents was available for 568; 253 of these patients (44%) used anti-thrombotic agents. Compared to patients not taking anti-thrombotic agents, patients treated with anti-thrombotics were older (P <.001), had a higher mean American Society of Anesthesiologists classification score (P <.0001), had a higher mean Rockall score (P <.0001), a higher mean AIMS65 score (P <.0001), and more frequently bled from ulcers (P <.001). There were no differences between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion. All-cause mortality was lower in patients who took anti-thrombotic drugs (11 deaths, 4%) than in patients who did not (37 deaths, 12%) (P =.002); this was due to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1%) than in patients who were not (19 deaths, 6%) (P =.003). Patients taking anti-thrombotic drugs had mean hospital stays of 6.9 days (95% CI, 2–23 days) compared to 7.9 days for non-users of anti-thrombotic agents (95% CI, 2–26 days) (P =.04). Conclusions: Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.

AB - Background & Aims: Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. Methods: We performed a prospective study of 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015. We collected data recorded on use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores. We also collected and analyzed data on co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality. Results: Of the 619 patients who required endoscopic therapy, data on use of anti-thrombotic agents was available for 568; 253 of these patients (44%) used anti-thrombotic agents. Compared to patients not taking anti-thrombotic agents, patients treated with anti-thrombotics were older (P <.001), had a higher mean American Society of Anesthesiologists classification score (P <.0001), had a higher mean Rockall score (P <.0001), a higher mean AIMS65 score (P <.0001), and more frequently bled from ulcers (P <.001). There were no differences between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion. All-cause mortality was lower in patients who took anti-thrombotic drugs (11 deaths, 4%) than in patients who did not (37 deaths, 12%) (P =.002); this was due to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1%) than in patients who were not (19 deaths, 6%) (P =.003). Patients taking anti-thrombotic drugs had mean hospital stays of 6.9 days (95% CI, 2–23 days) compared to 7.9 days for non-users of anti-thrombotic agents (95% CI, 2–26 days) (P =.04). Conclusions: Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.

KW - Anticlotting Drug

KW - Complication

KW - Endoscopy

KW - Glasgow Blatchford Score

KW - Rate of Death

U2 - 10.1016/j.cgh.2018.04.046

DO - 10.1016/j.cgh.2018.04.046

M3 - Journal article

C2 - 29705263

VL - 17

SP - 440-447.e2

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 3

ER -