Outcome of non-variceal acute upper gastrointestinal bleeding in patients with antithrombotic therapy

To determine the influence of antithrombotic therapy upon the course of non-variceal upper gastrointestinal bleeding (UGB).

A cohort study was made of consecutive patients admitted to hospital with non-variceal UGB. Three cohorts were defined: patients receiving vitamin K antagonists (AC); patients with antiplatelet treatment (AP), and patients with neither of these treatments (noACAP) as control group. Outcome was assessed by: (a) number of days in hospital; (b) mortality rate; (c) need for urgent surgery, and (d) rebleeding. The measure of the association between antithrombotic therapy and the course of UGB was adjusted for confounders (age, sex, comorbidity, and the use of NSAIDs and PPIs at the time of UGB presentation).

A total of 392 consecutive patients were included: 43 were AC, 107 AP, and 242 noACAP patients. There were no significant differences among groups in terms of rebleeding (AC 11.6%, AP 7.5%, NoACAP 9.1%), the need for urgent surgery (AC 2.3%, AP 1.9%, NoACAP 1.2%) or mortality rate (AC 4.7%, AP 5.6%, NoACAP 5.8%). The number of days in hospital was greater in the AC cohort (4.81 more days; 95% CI 2.83-6.79, p < 0.001). After adjusting for age and comorbidity, the increase in days in hospital among the AC patients was 3.24 days (95% CI 1.22-5.26).

Neither anticoagulation nor antiplatelet treatment exerts an influence upon the course of non-variceal UGB. Nevertheless, anticoagulation is associated with a longer hospital stay. This is partially explained by the older age and increased comorbidity of the patients subjected to such treatment.