Vnitr Lek 2015, 61(12):1016-1022

Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding

Veronika Belanová^1,*, Martin Gřiva²

¹ Oddělení intenzivní péče operačních oborů Krajské nemocnice T. Bati, a.s., Zlín, vedoucí pracoviště prim. MUDr. Anna Šobáňová

² Kardiocentrum pro dospělé Interní kliniky Krajské nemocnice T. Bati, a.s., Zlín, vedoucí pracoviště prim. MUDr. Jiří Latta

Background:
The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90 %. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding.

Objectives:
To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication.


Design and methods:
Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobin < 100 g/l) with proved source of blood losses in upper gastrointestinal tract during a hospital stay in 2013 (from January to June).

Results:
We included 111 patients of average age 69 ± 15 years, men 60 %. Nonvariceal bleeding accounted for 90 % of the cases. None of the patients with variceal bleeding (10 % of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70 ± 15, 61 % men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73 % of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54 %). 32 % of patients with nonvariceal bleeding had antiplatelets, 19 % anticoagulants and 10 % used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11 %, annual mortality was 23 %. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25 % of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment.

Conclusion:
Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobin < 100 g/l) significantly higher portions of patients are taking antiplatelet rather than anticoagulation therapy. This may be caused by greater use of these drugs in the population, but on the other hand it may reflect an association with greater risk of gastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even though they do not meet the indication for the prescription according to the guidelines.

Keywords: antiplatelet therapy and anticoagulation; upper gastrointestinal bleeding

Received: April 13, 2015; Accepted: July 28, 2015; Published: December 1, 2015  Show citation