Introduction Upper gastrointestinal bleeding (UGIB) is a recognised risk of antithrombotic therapy. We aimed to investigate whether patients admitted with UGIB whilst on antithrombotic therapy were continued on these following discharge, and to assess bleeding and cardiovascular outcomes.
Method We performed a retrospective cohort study on consecutive inpatients referred to our university hospital for suspected UGIB over 18 months, who had been prescribed antithrombotic therapy at the point of admission. Patients were identified through our electronic database, and records were scrutinised for co-morbidities, antithrombotic indication (s), endoscopy findings, endotherapy and rebleeding. Primary outcomes included mortality and cardiovascular events at 1 year, whereas secondary outcomes included rebleed rates, and discontinuation of antiplatelet/anticoagulant therapy. Statistical analysis was performed using Fisher’s Exact test.
Results 133 patients were included in the study, with a median age of 76 years (SD), of which 65.4% were male. Median follow-up was 255 days. Antithrombotic therapy consisted of aspirin monotherapy (44.4%), clopidogrel (9.7%), dual antiplatelet therapy (16.5%), anticoagulant (23.2%), with coronary artery disease (47.5%), atrial fibrillation (18.6%), cerebrovascular disease (9.3%) being the primary indications. Peptic ulcer disease was the commonest lesion on endoscopy (34%), followed by normal endoscopy (28.6%), gastritis (12.8%), and oesophagitis (7.5%). Intervention was performed in 30% of cases. Our 30-day rebleed rate was 5.2%. 30-day and 1-year all-cause mortality rates were 9.0% and 21.0% respectively. Antithrombotic therapy was at least partially discontinued in 55.2% of patients, with no concordance to Rockall scoring or endoscopic findings. Independent predictors of antithrombotic continuation included: metallic heart valve, coronary artery stenting within one year, and recent venous thromboembolism. At 1 year of follow-up, discontinuation of antithrombotic therapy was associated with increased cardiovascular mortality (RR 4.5, p = 0.036), increased all-cause mortality (RR 3.0, p = 0.003), and cardiovascular events (RR 6.1, p = 0.003). Continuation of antithrombotic therapy following haemostasis did not significantly increase bleeding-related mortality.
Conclusion Patients with cardiovascular comorbidity are at high risk of developing ischaemic events following admission for UGIB. Clinicians should consider careful risk-benefit assessment prior to discontinuing established antithrombotic treatment.
Disclosure of interest None Declared.
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