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. 2020 Sep 28;26(36):5463-5473.
doi: 10.3748/wjg.v26.i36.5463.

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Jacques Bouget  1 , Damien Viglino  2 , Quentin Yvetot  3 , Emmanuel Oger  4
Affiliations

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Jacques Bouget et al. World J Gastroenterol. .

Abstract

Background: There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic.

Aim: To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events.

Methods: Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.

Results: Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations (P = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use (P = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy vs dual antiplatelet agents.

Conclusion: We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%).

Keywords: Antithrombotics; Bleeding; Emergency; Management; Mortality; Real-world setting.

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Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to report.

Figures

Figure 1
Figure 1
Antithrombotic classes according to gastro-intestinal bleeding lesion location. Overall chi-square test P value = 0.03. All pair-wise comparisons with Bonferroni correction > 0.10 except for direct oral anticoagulant compared to AP (P value = 0.02). AP: Antiplatelet agent; DOAC: Direct oral anticoagulant; GI: Gastrointestinal; VKA: Vitamin K antagonist.
Figure 2
Figure 2
Antithrombotic classes according to gastro-duodenal ulcer and proton pump inhibitor use. General association statistic P value = 0.05. AP: Antiplatelet agent; DOAC: Direct oral anticoagulant; VKA: Vitamin K antagonist.
Figure 3
Figure 3
Antithrombotic classes according to gastro-intestinal bleeding type and in-hospital mortality. General association statistic P value = 0.09. AP: Antiplatelet agent; DOAC: Direct oral anticoagulant; VKA: Vitamin K antagonist.
See this image and copyright information in PMC

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