Improved Survival for Patients Suffering From Acute Upper Gastrointestinal Bleeding While On Anti-Thrombotic Therapy: A Multicenter Prospective Cohort Study

Aims Anti-thrombotic agents (ATs) are risk factors for acute upper gastrointestinal bleeding (AUGIB), but their impact on clinical outcomes is still uncertain. Aim of the study was to determine if patients with AUGIB while on ATs are at higher risk for mortality and rebleeding.

Methods We conducted a prospective, multicenter cohort study enrolling all the consecutive patients presenting with AUGIB (either non-variceal, NV-AUGIB or variceal, V-AUGIB) in 50 Italian hospitals from 1 January 2014 to 31 December 2015. Baseline clinical data, laboratory tests, comorbidities, prognostic scores, received therapies and outcomes (death, rebleeding, salvage surgery/radiology, transfusions, length of hospitalization) were compared between ATs-users and non-users.

Results 3324 patients with AUGIB (2764 NV-AUGIB, 83.2 % and 560 V-AUGIB, 16.8 %) were enrolled, 1399 (42.1 %) on ATs. Patients taking ATs were older (75.4 vs 62.8 years, p < 0.001) and had higher ASA, Rockall and Glasgow-Blatchford scores (p < 0.001 for all scores). Patients not taking ATs presented more frequently with hematemesis (p < 0.001), shock (p=0.003) and V-AUGIB (25.2 % vs 5.3 %, p < 0.001) and received more frequently an endoscopic treatment (60.4 % vs 54.5 %, p < 0.001). Compared to patients not taking ATs, ATs-users showed similar overall (6.0 % vs 7.2 %, p=0.17), NV-AUGIB (5.4 % vs 6.0 %, p=0.12) and “high-risk” NV-AUGIB (bleeding needing endoscopic therapy, 6.9 % vs 5.4 %, p=0.24) mortality, and lower V-AUGIB mortality (6.8 % vs 12.7 %, p<0.001). At multivariate analysis with comorbidities, use of ATs resulted a protective factor for death (OR 0.63, 95 % CI 0.45 – 0.87, p=0.006). Rebleeding (5.5 % vs 5.8 %, p=0.71) and need for salvage surgery/radiology (4.2 % vs 4.8 %, p=0.41) were similar in the two groups. ATs-users received more frequently transfusions (62.3 % vs 53.5 %, p<0.001) and had longer hospital stays (10.6 ± 9.8 vs 9.2 ± 9.8 days, p<0.001).

Conclusions Despite being older and frailer, patients presenting with AUGIB while on ATs have improved survival compared to those not taking ATs, with a similar risk of rebleeding.

Citation: Marmo R, Soncini M, Occhipinti V et al. OP150 IMPROVED SURVIVAL FOR PATIENTS SUFFERING FROM ACUTE UPPER GASTROINTESTINAL BLEEDING WHILE ON ANTI-THROMBOTIC THERAPY: A MULTICENTER PROSPECTIVE COHORT STUDY. Endoscopy 2021; 53: S61.

Publication History

Article published online:
19 March 2021