Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2018; 24(34): 3908-3918
Published online Sep 14, 2018. doi: 10.3748/wjg.v24.i34.3908
Gastroduodenal ulcer bleeding in elderly patients on low dose aspirin therapy
Koh Fukushi, Keiichi Tominaga, Kazunori Nagashima, Akira Kanamori, Naoya Izawa, Mimari Kanazawa, Takako Sasai, Hideyuki Hiraishi
Koh Fukushi, Keiichi Tominaga, Kazunori Nagashima, Akira Kanamori, Naoya Izawa, Mimari Kanazawa, Hideyuki Hiraishi, Department of Gastroenterology, Dokkyo Medical University, Tochigi 3210293, Japan
Takako Sasai, Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama 700850, Japan
Author contributions: All authors contributed to this research study; Fukushi K contributed to manusucript writing, performing procedures and data analysis; Tominaga K, Sasai T and Hiraishi H contributed to draft conception and design; Nagashima K contributed to data analysis; Nagashima K, Kanamori A, Izawa N and Kanazawa M contributed to writing the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Dokkyo Medical University.
Informed consent statement: Patients were not required to give informed consent to this study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: 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. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keiichi Tominaga, MD, PhD, Doctor, Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotuga, Tochigi 3210293, Japan. tominaga@dokkyomed.ac.jp
Telephone: +81-282-872147 Fax: +81-282-867761
Received: April 4, 2018
Peer-review started: April 4, 2018
First decision: May 29, 2018
Revised: July 12, 2018
Accepted: July 22, 2018
Article in press: July 21, 2018
Published online: September 14, 2018
Abstract
AIM

To determine the clinical characteristics of elderly patients of hemorrhagic gastroduodenal ulcer on low-dose aspirin (LDA) therapy.

METHODS

A total of 1105 patients with hemorrhagic gastroduodenal ulcer treated in our hospital between January 2000 and March 2016 were grouped by age and drugs used, and these groups were compared in several factors. These groups were compared in terms of length of hospital stay, presence/absence of hemoglobin (Hb) decrease, presence/absence of blood transfusion, Forrest I, percentage of Helicobacter pylori infection, presence/absence of underlying disease, and percentage of severe cases.

RESULTS

The percentage of blood transfusion (62.6% vs 47.7 %, P < 0.001), Hb decrease (53.8% vs 40.8%, P < 0.001), and the length of hospital stay (23.5 d vs 16.7 d, P < 0.001) were significantly greater in those on drug therapy. The percentage of blood transfusion (65.3% vs 47.8%, P < 0.001), Hb decrease (54.2% vs 42.1%, P < 0.001), and length of hospital stay (23.3 d vs 17.5 d, P < 0.001) were significantly greater in the elderly. In comparison with the LDA monotherapy group, the percentage of severe cases was significantly higher in the LDA combination therapy group when elderly patients were concerned (16.1% vs 34.0%, P = 0.030). Meanwhile, among those on LDA monotherapy, there was no significant difference between elderly and non-elderly (16.1% vs 16.0%, P = 0.985).

CONCLUSION

A combination of LDA with antithrombotic drugs or non-steroidal anti-inflammatory drugs (NSAIDs) contributes to aggravation. And advanced age is not an aggravating factor when LDA monotherapy is used.

Keywords: Hemorrhagic gastroduodenal ulcer, Low-dose aspirin, Antithrombotic drugs, Elderly patients, Proton pump inhibitor

Core tip: A total of 1105 patients with hemorrhagic gastroduodenal ulcer were grouped by age and drugs used, and these groups were compared in several factors. Among the elderly (over 70 years), the rate of severe conditions was significantly higher in patients receiving low-dose aspirin (LDA) combination therapy than in those receiving LDA monotherapy. Meanwhile, in the LDA monotherapy group, no significant difference in the rate of severe conditions was observed between elderly and non-elderly patients. This result suggests LDA combination therapy contributes to the aggravation, and advanced age is not an aggravating factor when LDA monotherapy is used.