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
ARTICLE HIGHLIGHTS
Research background

There are few reports on the characteristics of major gastrointestinal (GI) bleeding in patients exposed to different antithrombotics.

Research motivation

There are conflicting results when reporting GI bleeding causative lesions across different antithrombotics. In addition, severity and case fatality are poorly known.

Research objectives

The main objective was to describe the characteristics, causative lesions, management and fatalities related to major GI bleeding events for patients receiving an antithrombotic. A secondary objective was to compare the distribution of antithrombotics between upper and lower GI bleeding, and finally to compare the distribution of antithrombotics between patients with gastro-duodenal ulcer and patients with other identified causes of upper GI bleeding.

Research methods

Over a three-year period (2013-2015), in two tertiary care hospitals in France, we prospectively identified adult patients admitted for major GI bleeding while receiving an antithrombotic. Patients were screened at emergency admission by computerised requests on electronic health records. All screened records were medically validated. Major bleeding was defined on pre-specified criteria. Data were collected from emergency department clinical records and hospital medical records.

Research results

We observed a high rate of identification of causative bleeding lesions. There was a higher proportion of direct oral anticoagulant use among patients with lower GI locations than among those with upper GI lesion locations. Dual antiplatelet regimen was more frequently encountered among patients with gastro-duodenal ulcers. Our data did not support differences in management and outcomes across the various antithrombotics. In-hospital mortality was low.

Research conclusions

Our results suggest a different pattern of antithrombotic exposure between GI lesion locations.

Research perspectives

Future research could assess potential difference between direct oral anticoagulants.