Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;27(1):102-112.
doi: 10.5853/jos.2024.00661. Epub 2025 Jan 31.

Long-Term Incidence of Gastrointestinal Bleeding Following Ischemic Stroke

Jun Yup Kim  1 , Beom Joon Kim  1 , Jihoon Kang  1 , Do Yeon Kim  1 , Moon-Ku Han  1 , Seong-Eun Kim  1 , Heeyoung Lee  2 , Jong-Moo Park  3 , Kyusik Kang  4 , Soo Joo Lee  5 , Jae Guk Kim  5 , Jae-Kwan Cha  6 , Dae-Hyun Kim  6 , Tai Hwan Park  7 , Kyungbok Lee  8 , Hong-Kyun Park  9 , Yong-Jin Cho  9 , Keun-Sik Hong  9 , Kang-Ho Choi  10 , Joon-Tae Kim  10 , Dong-Eog Kim  11 , Jay Chol Choi  12 , Mi-Sun Oh  13 , Kyung-Ho Yu  13 , Byung-Chul Lee  13 , Kwang-Yeol Park  14 , Ji Sung Lee  15 , Sujung Jang  16 , Jae Eun Chae  16 , Juneyoung Lee  16 , Min-Surk Kye  1 , Philip B Gorelick  17 , Hee-Joon Bae  1 ; CRCS-K Investigators  1
Affiliations

Long-Term Incidence of Gastrointestinal Bleeding Following Ischemic Stroke

Jun Yup Kim et al. J Stroke. 2025 Jan.

Abstract

Background and purpose: Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes.

Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data.

Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4.

Conclusion: Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Keywords: Gastrointestinal bleeding; Ischemic stroke; Medical complications.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

H-J Bae reports grants from AstraZeneca, Bayer Korea, Bristol Myers Squibb Korea, Chong Gun Dang Pharmaceutical Corp., Dong-A ST, Jeil Pharmaceutical Co., Ltd., Korean Drug Co., Ltd., Samjin Pharm, Takeda Pharmaceuticals Korea Co., Ltd., and Yuhan Corporation; roles as a principal investigator or co-investigator of clinical trials sponsored by Bayer, Bristol Myers Squibb, GNT Pharma, Korean Drug Co., Ltd., and Shinpoong Pharm. Co., Ltd.; and personal fees from Amgen Korea, Bayer, Daiichi Sankyo, JW Pharmaceutical, Hanmi Pharmaceutical Co., Ltd., Otsuka Korea, SK Chemicals, and Viatris Korea outside the submitted work. The remaining authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Time distribution of major gastrointestinal bleeding events following acute ischemic stroke. Major gastrointestinal bleeding was defined as bleeding leading to the transfusion of two or more units of whole blood or red blood cells.
Figure 2.
Figure 2.
Cumulative incidence function for major gastrointestinal bleeding following acute ischemic stroke.
Figure 3.
Figure 3.
Adjusted IRR (95% CI) of selected variables for major GI bleeding following acute ischemic stroke. GI, gastrointestinal; NIHSS, National Institutes of Health Stroke Scale; IV tPA, intravenous tissue plasminogen activator; NSAID, nonsteroidal anti-inflammatory drug; eGFR, estimated glomerular filtration rate; ASA, aspirin; AP, antiplatelet; AC, anticoagulant; mRS, modified Rankin Scale; IRR, incidence rate ratio; CI, confidence interval.
See this image and copyright information in PMC

References

    1. U.S. Preventive Services Task Force Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396–404. - PubMed
    1. Sehested TSG, Carlson N, Hansen PW, Gerds TA, Charlot MG, Torp-Pedersen C, et al. Reduced risk of gastrointestinal bleeding associated with proton pump inhibitor therapy in patients treated with dual antiplatelet therapy after myocardial infarction. Eur Heart J. 2019;40:1963–1970. - PubMed
    1. Moscucci M, Fox KA, Cannon CP, Klein W, López-Sendón J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE) Eur Heart J. 2003;24:1815–1823. - PubMed
    1. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, Armstrong PW, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA. 2004;292:1555–1562. - PubMed
    1. Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114:774–782. - PubMed

LinkOut - more resources