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Published on: September 18, 2014
Etiology of gastrointestinal bleeding in patients on dual antiplatelet therapy
Arslan Shaukat1, Salman Waheed1, Ethan Alexander2
1Division of Cardiovascular Diseases, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
Insights
Dual antiplatelet therapy (DAPT) does not significantly alter the risk of upper or lower gastrointestinal bleeding (GI). Endoscopic findings and causes of GI bleeding were similar between patients on DAPT and those not on DAPT.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Dual antiplatelet therapy (DAPT) is linked to increased gastrointestinal (GI) bleeding risk, particularly upper GI bleeding (UGIB).
- Emerging evidence suggests a potential rise in lower GI bleeding (LGIB) among patients using DAPT.
Purpose of the Study:
- To compare the endoscopic findings and etiologies of GI bleeding in patients on DAPT versus those not on DAPT.
- To investigate whether DAPT influences the location (UGIB vs. LGIB) or cause of GI bleeding.
Main Methods:
- A retrospective, single-center, case-control study.
- 114 patients with GI bleeding on DAPT (cases) were compared with 114 patients with GI bleeding not on DAPT (controls).
- Detailed GI evaluation was performed for all included patients.
Main Results:
- No significant difference in the incidence of UGIB or LGIB was observed between the DAPT and control groups (P = 0.10).
- Within each group, the distribution of UGIB versus LGIB was also not significantly different.
- The DAPT group showed a higher likelihood of bleeding from varices or upper GI inflammation and a higher percentage of unidentified bleeding etiologies (22.8% vs. 5.3%).
Conclusions:
- The incidence of both UGIB and LGIB is similar in patients with GI bleeding, regardless of DAPT use.
- While overall rates are similar, DAPT may be associated with specific bleeding sources like varices or inflammation, and a higher rate of undetermined causes.
Objective:
Dual antiplatelet therapy (DAPT) is associated with an increased risk of gastrointestinal (GI) bleeding and is thought to cause upper gastrointestinal bleeding (UGIB). However, recent reports indicate that the incidence of lower gastrointestinal bleeding (LGIB) in patients on DAPT may be increasing. We aimed to compare the endoscopic findings and etiology of GI bleeding between patients on DAPT compared with those not on DAPT.
Methods:
This was a retrospective, single-center, case-control study. Cases were 114 consecutive patients admitted with a first episode of GI bleeding while on DAPT who underwent detailed GI evaluation. We chose 114 controls who had GIB but were not on DAPT.
Results:
There was no significant difference in the incidence of UGIB or LGIB between the two groups (UGIB: 53.5% vs 51.3% and LGIB: 46.5% vs 48.7%, P = 0.10) or within groups (DAPT: 53.5% vs 46.5%, P = 0.30 and controls: 51.3% vs 48.7%, P = 0.80). Although the DAPT group had a lower prevalence of the usual UGIB risk factors, it had a higher likelihood of bleeding from varices or upper GI inflammation [odds ratio (OR) 3.54, 95% confidence interval (CI) 0.14-92.3; OR 13.98, 95% CI 1.40-140.36]. No etiology of bleeding was identified in a higher percentage of patients on DAPT than those who were not (22.8% vs 5.3%).
Conclusion:
In patients with GI bleeding, the incidences of UGIB and LGIB are similar irrespective of their DAPT use.
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