Recurrent Non-Variceal Upper Gastrointestinal Bleeding among Patients Receiving Dual Antiplatelet Therapy

Area of Science:

• Gastroenterology
• Cardiology
• Internal Medicine

Background:

• Dual antiplatelet therapy (DAPT) is crucial for preventing thrombotic events but can increase the risk of gastrointestinal bleeding (GIB).
• Recurrent GIB in patients on DAPT poses a significant clinical challenge, necessitating investigation into associated risk factors and outcomes.

Purpose of the Study:

• To investigate the clinical characteristics of patients experiencing non-variceal upper gastrointestinal bleeding (NVUGIB) while on DAPT.
• To identify risk factors associated with recurrent NVUGIB and mortality in patients treated with DAPT.

Main Methods:

• Retrospective enrollment of patients diagnosed with NVUGIB while receiving DAPT between 2006 and 2020.
• Confirmation of definite bleeding via esophagogastroduodenoscopy.
• Multivariate and Kaplan-Meier analyses to assess risk factors and survival probabilities.

Main Results:

• A total of 124 patients were included, predominantly male (83.1%), with most bleeding originating from the stomach (75.8%) due to peptic ulcers (58.1%).
• Recurrent upper GIB occurred in 29.0% of patients, with 15.3% experiencing all-cause mortality and 5.6% having bleeding-related deaths.
• Advanced age (≥70 years) was identified as a significant risk factor for re-bleeding (OR, 1.050), all-cause mortality (OR, 1.096), and bleeding-related mortality (OR, 1.187).

Conclusions:

• Elderly patients (≥70 years) experiencing NVUGIB while on DAPT exhibit significantly higher probabilities of re-bleeding and mortality.
• Clinicians must exercise heightened caution and consider risk-stratified management for older individuals presenting with NVUGIB during DAPT.