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Risk factors for short-term re-bleeding in patients with colonic diverticular bleeding: a multicenter retrospective
Takahiro Gonai1,2, Yosuke Toya1, Norihiko Kudara3
1Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Shiwa-gun, Japan.
Insights
Antithrombotic agents (ATs) increase the risk of re-bleeding in patients with colonic diverticular bleeding (CDB). Discontinuing ATs may lead to thromboembolic events, necessitating careful management.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Internal Medicine
Background:
- Colonic diverticular bleeding (CDB) poses a risk for short-term re-bleeding.
- Limited research exists on risk factors for recurrent CDB within a month.
Purpose of the Study:
- To identify independent risk factors for CDB re-bleeding within one month.
- To evaluate the role of antithrombotic agents (ATs) in CDB recurrence.
Main Methods:
- Retrospective analysis of 370 patients with CDB across 10 institutions (2015-2019).
- Cox proportional hazards models were used to assess risk factors for re-bleeding.
Main Results:
- Antithrombotic agent (AT) use was an independent risk factor for re-bleeding (HR 2.38).
- Use of multiple ATs (HR 3.88) and AT continuation (HR 3.30) significantly increased re-bleeding risk.
- Two patients discontinuing ATs experienced thromboembolic events.
Conclusions:
- Antithrombotic agents (ATs) are significant risk factors for short-term re-bleeding in colonic diverticular bleeding (CDB).
- Managing ATs requires balancing re-bleeding risk against potential thromboembolic events.
- Careful consideration of AT continuation or discontinuation is crucial for CDB patients.
Background And Aim:
Few studies have evaluated risk factors for short-term re-bleeding in patients with colonic diverticular bleeding (CDB). We aimed to reveal risk factors for re-bleeding within a month in patients with CDB.
Methods:
We retrospectively analyzed clinical course of patients with CDB diagnosed at 10 institutions between 2015 and 2019. Risk factors for re-bleeding within a month were assessed by Cox proportional hazards models.
Results:
Among 370 patients, 173 (47%) patients had been under the use of antithrombotic agents (ATs) and 34 (9%) experienced re-bleeding within a month. Multivariate analysis revealed that the use of ATs was an independent risk factor for re-bleeding within a month (HR 2.38, 95% CI 1.10-5.50, p = .028). Furthermore, use of multiple ATs and continuation of ATs were found to be independent risk factors for re-bleeding within a month (HR 3.88, 95% CI 1.49-10.00, p = .007 and HR 3.30, 95% CI 1.23-8.63, p = .019, respectively). Two of 370 patients, who discontinued ATs, developed thromboembolic event.
Conclusions:
Use of ATs was an independent risk factor for short-term re-bleeding within a month in patients with CDB. This was especially the case for the use of multiple ATs and continuation of ATs. However, discontinuation of ATs may increase the thromboembolic events those patients.
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