Changela Madhav, Pandey Sagar, Bahirwani Janak, Patel Nishit, Kaneriya Maulik, Basida Sanket D, Shah Anish, Thakur Rahul, Bodrya Krishna, Jai Kumar Ahuja Suruchi, Schneider Yecheskel
Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, NY 11213, United States.
Department of Gastroenterology, St. Luke's University Health Network, Bethlehem, PA 18015, United States.
World J Gastrointest Pharmacol Ther. 2024 Nov 5;15(6):95532. doi: 10.4292/wjgpt.v15.i6.95532.
Inflammatory bowel disease (IBD), with its rising prevalence rates is associated with an increased risk of cardiovascular and thromboembolic events. Antiplatelets and/or anticoagulants agents are often prescribed but the literature on the impact of long-term anticoagulation and/or antiplatelet use among patients hospitalized with IBD is scarce. The aim of this study is to assess the outcomes of patients hospitalized with IBD on antiplatelet and/or anticoagulant agents.
To investigate the effects of long-term use of antiplatelets/anticoagulants on clinical outcomes in patients hospitalized with IBD.
We conducted a retrospective cohort study using the Nationwide Inpatient Sample database, including all adult IBD patients hospitalized in the United States from 2016 to 2019. Patient cohorts were stratified based on antiplatelet/anticoagulant therapy status. Multivariate regression analysis was done to assess outcomes, adjusting for potential confounders. The primary outcome was mortality, whereas length of stay (LOS), total parenteral nutrition, acute kidney injury, sepsis, shock, gastrointestinal bleeding, need for colonoscopy/sigmoidoscopy, abdominal surgery and total hospitalization charges were secondary outcomes.
Among 374744 hospitalized IBD patients, antiplatelet or anticoagulant therapy alone was associated with significantly lower in-hospital mortality and reduced healthcare utilization, including shorter LOS and decreased hospitalization costs. Combined therapy was associated with a protective effect on mortality, but did not reach statistical significance. Notably, therapy did not exacerbate disease severity or complications, although higher odds of gastrointestinal bleeding were observed.
Our study highlights the potential benefits of long-term anticoagulation/antiplatelet therapy in hospitalized IBD patients, with improved mortality outcomes and healthcare utilization. While concerns regarding gastrointestinal bleeding exist, the overall safety profile suggests a role for these agents in mitigating thromboembolic risks without exacerbating disease severity. Further research is needed to look at optimal treatment strategies and addressing limitations to guide clinical decision-making in this population.
炎症性肠病（IBD）的患病率不断上升，与心血管和血栓栓塞事件风险增加相关。抗血小板和/或抗凝药物经常被处方使用，但关于IBD住院患者长期使用抗凝和/或抗血小板药物影响的文献很少。本研究的目的是评估IBD住院患者使用抗血小板和/或抗凝药物的结局。
探讨长期使用抗血小板/抗凝药物对IBD住院患者临床结局的影响。
我们使用全国住院样本数据库进行了一项回顾性队列研究，纳入2016年至2019年在美国住院的所有成年IBD患者。患者队列根据抗血小板/抗凝治疗状态进行分层。进行多变量回归分析以评估结局，并对潜在混杂因素进行校正。主要结局是死亡率，而住院时间（LOS）、全胃肠外营养、急性肾损伤、脓毒症、休克、胃肠道出血、结肠镜检查/乙状结肠镜检查需求、腹部手术和总住院费用是次要结局。
在374744例住院的IBD患者中，单独使用抗血小板或抗凝治疗与显著降低的住院死亡率和减少的医疗资源利用相关，包括更短的住院时间和降低的住院费用。联合治疗对死亡率有保护作用，但未达到统计学意义。值得注意的是，尽管观察到胃肠道出血的几率较高，但治疗并未加重疾病严重程度或并发症。
我们的研究强调了长期抗凝/抗血小板治疗对IBD住院患者的潜在益处，可改善死亡率结局和医疗资源利用。虽然存在对胃肠道出血的担忧，但总体安全性表明这些药物在降低血栓栓塞风险而不加重疾病严重程度方面具有作用。需要进一步研究以探讨最佳治疗策略并解决局限性，以指导该人群的临床决策。
