Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2020; 26(36): 5463-5473
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5463
Major gastrointestinal bleeding and antithrombotics: Characteristics and management
Jacques Bouget, Damien Viglino, Quentin Yvetot, Emmanuel Oger
Jacques Bouget, EA 7449 REPERES, Pharmacoepidemiology and Health Services Research, Univ Rennes, Rennes 35000, France
Damien Viglino, Emergency Department and Mobile Intensive Care Unit-HP2 Laboratory INSERM U1042, University Grenoble Alps, La Tronche 38700, France
Quentin Yvetot, Emergency Department, CHU Rennes, Rennes 3500, France
Emmanuel Oger, EA 7449 REPERES, Université de Rennes 1, Rennes 35000, France
Author contributions: Oger E was the guarantor; Oger E and Bouget J designed the study; Bouget J, Viglino D, and Yvetot Q participated in the acquisition of the data; Oger E and Bouget J participated in the analysis and interpretation of data, and drafted the initial manuscript; Viglino D and Yvetot Q revised the article critically for important intellectual content.
Supported by National Clinical Research Hospital Program of the French Ministry of Health, No. PHRC-12-009-0243.
Institutional review board statement: The study was reviewed and approved by Rennes University hospital Review Board. The study received regulatory approval (CNIL, DR-2013-488 with subsequent substantial changes DR-2016-489).
Informed consent statement: No informed and signed consent was needed for the basic survey.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Requests for anonymized data will be considered by Professor Bouget, jacques.bouget@univ-rennes1.fr.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Emmanuel Oger, MD, PhD, Professor, EA 7449 REPERES, Université de Rennes 1, Bat 6, Campus Santé Villejean, 2 avenue Professeur Bernard, Rennes 35000, France. emmanuel.oger@univ-rennes1.fr
Received: June 9, 2020
Peer-review started: June 9, 2020
First decision: July 29, 2020
Revised: July 30, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: September 28, 2020
Abstract
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%).

Keywords: Real-world setting, Emergency, Bleeding, Mortality, Antithrombotics, Management

Core tip: A large population requires long-term treatment with antithrombotics and gastrointestinal (GI) bleeding is the commonest bleeding manifestation. However, there are few reports on major GI bleeding among patients receiving an antithrombotic. We prospectively identified 1080 adult patients consecutively referred for major GI bleeding to emergency departments in two tertiary care hospitals between January 2013 and December 2015 while receiving an antithrombotic. Based on these data, we described clinical characteristics, bleeding locations, management and in-hospital mortality related to these events.