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Major gastrointestinal bleeding and antithrombotics: Characteristics and management
BACKGROUND: There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic. AIM: To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events. METHODS: Over a three-year period, we prospectively ident...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520611/ https://www.ncbi.nlm.nih.gov/pubmed/33024397 http://dx.doi.org/10.3748/wjg.v26.i36.5463 |
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author | Bouget, Jacques Viglino, Damien Yvetot, Quentin Oger, Emmanuel |
author_facet | Bouget, Jacques Viglino, Damien Yvetot, Quentin Oger, Emmanuel |
author_sort | Bouget, Jacques |
collection | PubMed |
description | BACKGROUND: There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic. AIM: To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events. METHODS: Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified. RESULTS: Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations (P = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use (P = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy vs dual antiplatelet agents. CONCLUSION: We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%). |
format | Online Article Text |
id | pubmed-7520611 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-75206112020-10-05 Major gastrointestinal bleeding and antithrombotics: Characteristics and management Bouget, Jacques Viglino, Damien Yvetot, Quentin Oger, Emmanuel World J Gastroenterol Observational Study BACKGROUND: There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic. AIM: To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events. METHODS: Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified. RESULTS: Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations (P = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use (P = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy vs dual antiplatelet agents. CONCLUSION: We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%). Baishideng Publishing Group Inc 2020-09-28 2020-09-28 /pmc/articles/PMC7520611/ /pubmed/33024397 http://dx.doi.org/10.3748/wjg.v26.i36.5463 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Observational Study Bouget, Jacques Viglino, Damien Yvetot, Quentin Oger, Emmanuel Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title | Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title_full | Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title_fullStr | Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title_full_unstemmed | Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title_short | Major gastrointestinal bleeding and antithrombotics: Characteristics and management |
title_sort | major gastrointestinal bleeding and antithrombotics: characteristics and management |
topic | Observational Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520611/ https://www.ncbi.nlm.nih.gov/pubmed/33024397 http://dx.doi.org/10.3748/wjg.v26.i36.5463 |
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