Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Area of Science:

• Gastroenterology
• Cardiology
• Pharmacology

Background:

• Major gastrointestinal (GI) bleeding is a serious complication in patients using antithrombotic medications.
• Limited data exists on the specific characteristics and outcomes of GI bleeding in this patient population.

Purpose of the Study:

• To characterize clinical features, bleeding sites, and management strategies for major GI bleeding in patients on antithrombotics.
• To determine in-hospital mortality rates associated with these bleeding events.

Main Methods:

• Prospective study of 1080 adult patients with major GI bleeding while on antithrombotics over three years (2013-2015).
• Inclusion of patients from two tertiary care hospitals.
• Medically validated bleeding events, with detailed recording of clinical characteristics, causative lesions, management, and outcomes.

Main Results:

• Upper GI bleeding occurred in 576 patients, lower GI in 504; no cause identified in 35.5%.
• Gastro-duodenal ulcers were the most common upper GI cause (209/408), colonic diverticulum the most common lower GI cause (120/289).
• Direct oral anticoagulant use was higher in lower GI bleeding. Gastro-duodenal ulcers showed an independent association with antithrombotic use.

Conclusions:

• Higher rates of bleeding lesion identification and distinct antithrombotic exposure patterns were observed between upper and lower GI bleeding sites.
• Management approaches were consistent across different antithrombotics.
• In-hospital mortality was low at 5.95%.