Dataset Information

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

ABSTRACT:

Background

Patients undergoing dual antiplatelet therapy (DAPT) may experience recurrent gastrointestinal bleeding (GIB). We investigated the clinical characteristics and risk factors for recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) in patients who had experienced NVUGIB while receiving DAPT.

Methods

We enrolled patients diagnosed with NVUGIB while receiving DAPT between 2006 and 2020. Definite bleeding was confirmed by esophagogastroduodenoscopy in all NVUGIB patients.

Results

A total of 124 patients were diagnosed with NVUGIB while receiving DAPT. They were predominantly male (n = 103, 83.1%), bleeding mostly from the stomach (n = 94, 75.8%) and had peptic ulcers (n = 72, 58.1%). After the successful hemostasis of NVUGIB, 36 patients (29.0%) experienced at least one episode of recurrent upper GIB, 19 patients (15.3%) died, and 7 (5.6%) patients had a bleeding-related death. Multivariate analysis showed that age was a significant factor for re-bleeding (odds ratio [OR], 1.050; 95% confidence interval [CI]: 1.001-1.102; p-value: 0.047), all-cause mortality (OR, 1.096; 95% CI: 1.020-1.178, p = 0.013), and re-bleeding-related mortality (OR, 1.187; 95% CI: 1.032-1.364, p-value: 0.016). In Kaplan-Meier analysis, the cumulative probabilities of re-bleeding, death, and bleeding-related death were significantly higher in patients aged 70 and older (p = 0.008, <0.001, and 0.009, respectively).

Conclusions

Clinicians should be cautious about re-bleeding and mortality in elderly patients who experience NVUGIB while receiving DAPT.

SUBMITTER: Yoo AY

PROVIDER: S-EPMC10670490 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Yoo Ah Young AY Joo Moon Kyung MK Park Jong-Jae JJ Lee Beom Jae BJ Kim Seung Han SH Kim Won Shik WS Chun Hoon Jai HJ

Diagnostics (Basel, Switzerland) 20231114 22

<h4>Background</h4>Patients undergoing dual antiplatelet therapy (DAPT) may experience recurrent gastrointestinal bleeding (GIB). We investigated the clinical characteristics and risk factors for recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) in patients who had experienced NVUGIB while receiving DAPT.<h4>Methods</h4>We enrolled patients diagnosed with NVUGIB while receiving DAPT between 2006 and 2020. Definite bleeding was confirmed by esophagogastroduodenoscopy in all NVUGIB p ...[more]

PMID: 37998579

Similar Datasets

Project description:BackgroundNon-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%, with the clinical and economic burden expected to continue to increase. In the United States, non-variceal upper gastrointestinal bleeding (NVUGIB) has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15% based on co-morbidity burden.AimTo identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.MethodsWe utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States. This population was divided based on the presence and absence of NAFLD. Hospitalization characteristics, outcomes and complications were compared.ResultsThe total number of hospitalizations for NVUGIB was 799785, of which 6% were found to have NAFLD. NAFLD and GIB was, on average, more common in younger patients, females, and Hispanics than GIB without NAFLD. Interestingly, GIB was less common amongst blacks with NAFLD. Multivariate logistic regression analysis was conducted, controlling for the multiple covariates. The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GIB [adjusted odds ratio (aOR) = 1.018 (1.013-1.022)]. Secondary outcomes of interest, shock [aOR = 1.015 (1.008-1.022)], acute respiratory failure [aOR = 1.01 (1.005-1.015)] and acute liver failure [aOR = 1.016 (1.013-1.019)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher total hospital charges (THC) [$2148 ($1677-$2618)]; however, were less likely to have a longer length of stay [0.27 d (0.17-0.38)]. Interestingly, in our study, the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR = 0.992 (0.989-0.995)]. Patients with NAFLD were not more likely to suffer acute kidney injury, sepsis, blood transfusion, intubation, or dialysis.ConclusionNVUGIB in NAFLD hospitalizations had higher inpatient mortality, THC, and complications such as shock, acute respiratory failure, and acute liver failure compared to those without NAFLD.

Project description:BackgroundIt is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population.Methods and findingsLinked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤ 50 years, 95% CI 3.0%-4.3%) to 15.2% (≥ 80 years, 14.2%-16.3%), representing an excess over controls of between 3.6% (3.0%-4.2%) and 13.4% (12.4%-14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤ 50 years, 3.4%-4.8%) to 46.6% (≥ 80 years, 45.2%-48.1%), representing an excess over controls of between 3.8% (3.1%-4.5%) and 19.0% (17.5%-20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets.ConclusionsDeaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co-morbid illness seemingly unrelated to the bleed.

Project description:BackgroundNon-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization and associated morbidity and mortality. Bariatric surgery is a widely performed category of gastrointestinal (GI) surgery that attempts to induce weight loss by reconstructing the upper GI tract. Bleeding is a common complication of bariatric surgery; however, limited research exists on outcomes for these patients when admitted for NVUGIB compared to those without a history of bariatric surgery. Our study aims to evaluate the outcomes of post-bariatric surgery patients (PBSPs) admitted with NVUGIB over a 13-year span.MethodsThe National Inpatient Sample (NIS) from 2008 to 2020 was used to identify patients over 18 years old admitted for NVUGIB using the International Classification of Disease (ICD), 9th revision (ICD-9) and 10th revision (ICD-10) codes. Records were weighted using the algorithms provided by the NIS. Primary outcomes of interest were all-cause hospital mortality, shock, acute myocardial infarction (AMI), acute kidney injury (AKI), and a composite of these. Groups were defined based on the history of bariatric surgery, and demographics and incidence of comorbidities were compared. Outcomes were compared between the two groups, and odds ratios (ORs) were calculated using two-stage weighted logistic regression. ORs were adjusted for common co-founders such as age, gender, race, Charlson comorbidity index (CCI), region, hospital size, hospital teaching status, elective vs. emergency admission, and income quartile.ResultsA total of 2,231,826 patients admitted for NVUGIB were included in this study. Of these, 28,167 had a history of bariatric surgery. Overall, bariatric surgery patients were younger, less complicated (CCI: 2.71 vs. 4.76), had a shorter length of stay (LOS), and were less likely to be on Medicare/Medicaid than those without a history of bariatric surgery (P<0.05). Several comorbidities were more common in patients without a history of bariatric surgery, including coronary artery disease, hyperlipidemia (HLD), congestive heart failure (CHF), type 2 diabetes mellitus (T2DM), end-stage renal disease (ESRD), and liver cirrhosis (P<0.05). Other comorbidities were more common in the post-bariatric surgery group, including gastroesophageal reflux disease and anemia (P<0.05). We found that patients admitted for NVUGIB with a history of bariatric surgery had significantly lower odds of all outcomes, including all-cause mortality (OR =0.48; P<0.001), AKI (OR =0.71; P<0.001), AMI (OR =0.62; P<0.05), shock (OR =0.88; P<0.05), and a composite of these four (OR =0.77; P<0.001).ConclusionsOur study found that patients with NVUGIB and a history of bariatric surgery had substantially decreased odds of mortality, AMI, shock, and AKI compared to patients without a history of bariatric surgery. This suggests that patients with a history of bariatric surgery experienced more minor bleeds than other patients. Further studies are therefore warranted to understand the postoperative risk of bariatric surgery.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

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