Division of Gastroenterology and Hepatology.
Biostatistics Support Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e490-e498. doi: 10.1097/MEG.0000000000002148.
BACKGROUND/AIM: We determined the effect of antiplatelet and anticoagulant agents on rebleeding and mortality in patients with gastrointestinal bleeding.
This was a prospective study of patients admitted with gastrointestinal bleeding between 2013 and 2018. Outcomes were compared among patients on antiplatelet agents only, anticoagulant drugs only, combination therapy, and none. The association between mortality, rebleeding, and type of antithrombotic medication on admission and discharge was determined using multivariate analysis.
A total of 509 patients were followed up for a median of 19 months. End of follow-up rebleeding and mortality rates were 19.4% and 23.0%, respectively. Independent predictors of mortality were age [hazard ratio (HR) = 1.025 per year increase, P = 0.002], higher Charlson Comorbidity Index (HR = 1.4, P < 0.0001), severe bleeding (HR = 2.1, P < 0.0001), and being on anticoagulants (HR = 2.3, P = 0.002). Being on antiplatelets was protective against rebleeding (HR = 0.6, P = 0.047). Those on anticoagulants were more likely to die (HR = 2.5, P < 0.0001) and to rebleed (HR = 2.1, P = 0.01) than those on antiplatelets. Antithrombotic drug discontinuation upon discharge was associated with increased mortality in patients with cardiovascular disease.
In gastrointestinal bleeding, rebleeding and mortality were associated with being on anticoagulant drugs, while being on antiplatelet agents was protective against rebleeding. Discontinuation of antithrombotics upon discharge increased the risk of death. The findings inform risk stratification and decisions regarding continuation or discontinuation of antithrombotics.
背景/目的：我们旨在确定抗血小板和抗凝药物对胃肠道出血患者再出血和死亡率的影响。
这是一项对 2013 年至 2018 年期间因胃肠道出血入院的患者进行的前瞻性研究。比较了仅使用抗血小板药物、仅使用抗凝药物、联合治疗和未使用抗血栓药物的患者之间的结局。使用多变量分析确定入院和出院时死亡率、再出血与抗血栓药物类型之间的关联。
共随访了 509 例患者，中位随访时间为 19 个月。随访结束时的再出血和死亡率分别为 19.4%和 23.0%。死亡率的独立预测因素包括年龄[风险比（HR）=每年增加 1.025，P=0.002]、较高的 Charlson 合并症指数（HR=1.4，P<0.0001）、严重出血（HR=2.1，P<0.0001）和使用抗凝药物（HR=2.3，P=0.002）。使用抗血小板药物可降低再出血风险（HR=0.6，P=0.047）。与使用抗血小板药物相比，使用抗凝药物的患者更有可能死亡（HR=2.5，P<0.0001）和再出血（HR=2.1，P=0.01）。心血管疾病患者出院时停用抗血栓药物与死亡率增加相关。
在胃肠道出血中，再出血和死亡率与使用抗凝药物相关，而使用抗血小板药物可降低再出血风险。出院时停用抗血栓药物会增加死亡风险。这些发现为风险分层以及继续或停止使用抗血栓药物的决策提供了信息。
