COMPLEX ANTITHROMBOTIC THERAPY IN PATIENTS WITH ACUTE LOWER GASTROINTESTINAL BLEEDING: CLINICAL OUTCOMES

Aims Analyze the relationship of CAT (dual treatment: antiplatelet-anticoagulant or antiplatelet-antiplatelet) and the adverse outcomes in patients with acute lower gastrointestinal bleeding (LGB).

Methods International Classification of Diseases, 9th Revision, Clinical Modification codes for admission diagnosis were used to identify retrospectively a cohort of patients with LGB from January 2013 to December 2017 hospitalized in a tertiary care, university-affiliated hospital. The outcomes studied were: A) severe LGB, B) Re-bleeding, C) Transfusion requirements, D) Treatment (endoscopy, interventional radiology or surgery), E) Readmission and F) Death. For discrete variables we tested for significant differences between groups with X2 tests If ≥25 % of cells had expected values less than 5; Fisher exact test was used. P values < 0.05 were considered statistically significant. Differences in outcomes were expressed in odds ratio (OR) with 95% confidence intervals (95%CI).

Results Were identified 417 patients (88.5%) in not CAT group versus 54 (11.5%) in CAT group. Mean age was 76.8 years in CAT group versus 72.6 in not CAT group, 203 (48.7%) were men in not CAT group and 42 (77.8%) in patients using CAT. The most common source bleeding was diverticular 114 (27.3%) in not CAT group and ischemic colitis 13 (24.1%) in CAT group. Outcomes of patients are show in [Table 1.]

Tab. 1 Outcomes of patients admitted for LGB ( With CAT treatment versus without CAT treatment)

	With CAT 54(11.5%)	Without CAT 417 (88.5%)	OR (IC95%)
Severe LGB	24 (44.4%)	115(27.8%)	2.1 (1.18-3.75)
Transfusion/Rebleeding	23 (42.6%)/8 (14.3%)	105 (25.2%)/34(8.2%)	2.21(1.23-3.95)/1.96 (0.86-4.49)
Treatment/Readmission	10 (18.5%)/8 (14.3%)	50 (12 %)/12 (2.9%)	1.67 (0.79-3.52)/5.87 (2.28-15.1)
Death	0 (0%)	6 (1.4%)	2.1(1.18-3.75)

Conclusions Patients in CAT have a higher frequency of severe LGB; transfusion and readmission compared to patients without CAT. No difference was found between them for re-bleeding, need for treatment and death.