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Dual Antiplatelet Therapy and the Severity Risk of Lower Intestinal Bleeding
Neal Carlin1, Fady Asslo1, Raymund Sison2
1Department of Internal Medicine and Gastroenterology, St Joseph's Regional Medical Center, Paterson, NJ, USA.
Insights
Dual antiplatelet therapy, often combined with anticoagulants, is common for cardiac patients. This study found that while multiple blood thinners increase overall lower gastrointestinal bleeding (LGIB) risk, they do not significantly raise the risk of severe LGIB.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Dual antiplatelet therapy (aspirin and clopidogrel) is standard post-acute coronary syndrome.
- Many cardiac patients also receive anticoagulants like warfarin.
- Lower gastrointestinal bleeding (LGIB) is a primary concern with these regimens.
Purpose of the Study:
- To investigate the association between dual antiplatelet therapy and the incidence of LGIB.
- To determine if combined antithrombotic therapies increase LGIB risk.
Main Methods:
- Retrospective cohort study of 3436 patients admitted with LGIB.
- Electronic health records were reviewed for 19 variables, including medication use (aspirin, clopidogrel, NSAIDs, warfarin, heparin).
- Logistic regression analysis was used to assess associations between variables and LGIB.
Main Results:
- 511 patients had confirmed LGIB; 61 were on dual or multiple antithrombotic therapies.
- The use of multiple blood-thinning agents was associated with an increased risk of overall LGIB.
- However, this combination did not significantly elevate the risk of severe LGIB.
Conclusions:
- While multiple antithrombotic agents may increase the overall risk of lower gastrointestinal bleeding, they do not significantly increase the risk of severe LGIB.
Background:
Dual antiplatelet (Plt) therapy with aspirin and clopidogrel is recommended for up to 1 year following acute coronary syndrome. Many of these cardiac patients are also on anithrombotic therapy like warfarin. Lower gastrointestinal bleeding (LGIB) is the main adverse event of this treatment.
Aims:
The main purpose of this study was to analyze the relationship of dual anti-Plt therapy and the risk of LGIB.
Methods:
Patients' electronic charts were reviewed to include a total of 19 variables, which included age, sex, ethnicity, daily use aspirin of any dose, daily use of clopidogrel, use of nonsteroidal anti-inflammatory drugs (NSAIDs) at least twice in the last week prior to admission and the daily use of anticoagulants (warfarin, heparin), and were obtained from history and physical examination reports, lab transcripts and procedural reports.
Settings/Design:
A retrospective cohort study of the records of 3436 patients admitted to our hospital from January 1, 2009, to December 31, 2011, was evaluated. All the patients included were admitted through the emergency department with complaints of or relating to LGIB. The primary outcome studied was severe LGIB as defined by the requirement of at least two units of packed red blood cells and/or a decrease in the hematocrit of 20% or more or recurrent bleeding after 24 h of clinical stability with additional transfusions required. Other outcomes included surgical intervention.
Statistical Methods/Analysis:
Univariate analysis using t-test on continuous variables and Chi-square test on categorical variables were done before carrying out logistic regression analysis. Logistic regression analyses were conducted to measures of association between the variables and LGIB. Logistic regression analysis was not carried for surgical intervention and death because none of the variables was significant from univariate tests.
Results:
A total of 511 patients were found to have true LGIB. Among these subjects, 61 were shown to be on dual or multiple antithrombotic therapies. Further exploration revealed that while the use of multiple blood thinning agents may, in fact, pose a significant risk to overall LGIB, it did not significantly increase the risk for severe bleeding as outlined above.
Conclusion:
The use of multiple blood thinning agents does not significantly increase the risk for severe LGIB.
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