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Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19
Petrica Popa1, Sevastita Iordache1, Dan Nicolae Florescu1
1Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania.
Insights
Antithrombotic therapy use in upper gastrointestinal bleeding (UGIB) increased during the COVID-19 pandemic. While mortality remained similar, patients required more transfusions and fewer endoscopic interventions.
Area of Science:
- Gastroenterology
- Hematology
- Epidemiology
Background:
- Upper gastrointestinal bleeding (UGIB) incidence linked to antithrombotic therapy (AT) has risen.
- Direct oral anticoagulants (DOACs) and the COVID-19 pandemic may impact UGIB outcomes, particularly in high-risk patients.
Purpose of the Study:
- To investigate the trends and outcomes of AT use in UGIB patients.
- To compare mortality, rebleeding, and transfusion rates between patients with and without AT.
- To identify risk factors for mortality and assess UGIB incidence in COVID-19 patients.
Main Methods:
- Retrospective analysis of 5 years (Jan 2017-Dec 2021) of UGIB patients, including the COVID-19 pandemic period.
- Comparison of outcomes (mortality, rebleeding, transfusion) between patients on AT and those not on AT.
- Analysis of risk factors for mortality and UGIB incidence in hospitalized COVID-19 patients.
Main Results:
- AT use in UGIB was higher during the pandemic (24.39% vs. 13.8%).
- Age-adjusted mortality was similar between AT and non-AT groups (9.62% vs. unadjusted 12.21%), but Hb levels were lower, and transfusions were more frequent (>60%).
- Fewer therapeutic endoscopies were needed; UGIB incidence in COVID-19 patients was 0.58%.
Conclusions:
- AT in UGIB patients during the pandemic showed similar mortality but increased transfusion needs and reduced therapeutic endoscopy requirements.
- Risk factors for mortality included high GB score, no endoscopy, obscure/variceal bleeding, and LMWH vs. VKA therapy.
- DOACs showed a trend towards higher mortality than VKA, though not statistically significant.
Introduction:
During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding.
Patients And Methods:
We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017-December 2021) including Covid-19 pandemic period (March 2020-December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection.
Results:
A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion.
Conclusion:
Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.
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