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Risk of lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic

Neena S Abraham1, Christine Hartman, Peter Richardson

  • 1Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX (N.S.A.); Houston VA HSR&D Center of Excellence, Michael E. DeBakey VAMC, Houston, TX (N.S.A., C.H., P.R., D.C., R.L.S., A.D.N.); Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ (N.S.A); and Department of Communications, Texas A&M University, College Station, TX (R.L.S.).

Circulation
|September 13, 2013
PubMed

Insights

Complex antithrombotic therapy (CAT) in elderly patients significantly increases risks of upper and lower gastrointestinal bleeding (UGIE/LGIE), transfusions, and hospitalizations. All CAT strategies showed increased UGIE risk, with some leading to higher LGIE and hospitalization rates.

Area of Science:

  • Gerontology
  • Gastroenterology
  • Pharmacology

Background:

  • Elderly patients prescribed complex antithrombotic therapy (CAT) face elevated risks of gastrointestinal bleeding.
  • Quantifying upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations is crucial for this demographic.

Purpose of the Study:

  • To assess the incidence and risks of UGIE, LGIE, transfusions, and hospitalizations associated with various CAT regimens in elderly veterans.
  • To compare the safety profiles of anticoagulant-antiplatelet, aspirin (ASA)-antiplatelet, ASA-anticoagulant, and triple therapy (TRIP).

Main Methods:

  • A national cohort of 78,133 veterans aged 60+ prescribed CAT was identified from pharmacy and healthcare databases (2002-2008).
  • Outcomes (UGIE, LGIE, transfusions, hospitalizations) were determined using diagnostic codes and chart abstraction.
  • Incidence density ratios and survival analyses were performed to compare risks across different CAT strategies.

Main Results:

  • The incidence of UGIE was 20.1/1000 patient-years and LGIE was 70.1/1000 patient-years.
  • All CAT strategies increased UGIE risk by 40-60%.
  • ASA-anticoagulant and TRIP therapies were linked to the highest rates of transfusions and hospitalizations, with significant increases in LGIE also observed.

Conclusions:

  • Complex antithrombotic therapy in elderly patients presents clinically significant risks of gastrointestinal bleeding (LGIE and UGIE).
  • These bleeding events frequently necessitate transfusions and hospitalizations, highlighting the need for careful risk-benefit assessment in prescribing CAT.
Abstract

Keywords:
antiplatelet agentsantithrombotic agentsassessment, patient outcomeblood component transfusionhospitalization

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