Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy.
Ann Med
; 55(2): 2253822, 2023.
Article
em En
| MEDLINE
| ID: mdl-37672507
ABSTRACT
OBJECTIVE:
Non-variceal upper gastrointestinal bleeding (NVUGIB) in patients receiving oral anticoagulants (OACs) may be fatal; however, little is known about re-bleeding and all-cause mortality after successful hemostasis. We investigated the clinical characteristics and risk factors for re-bleeding and death after successful hemostasis.METHODS:
Patients receiving OACs and diagnosed with NVUGIB between 2007 and 2021 were enrolled. All NVUGIB incidents were confirmed if definite bleeding in the upper gastrointestinal tract was detected via esophagogastroduodenoscopy.RESULTS:
A total of 132 patients receiving OACs were diagnosed with NVUGIB. Males were the majority (72, 54.5%), and bleeding was detected mostly in the stomach (99, 75%) and was most often due to peptic ulcers (PU) (88, 66.7%). After successful hemostasis of index NVUGIB, 40 patients (30.3%) experienced re-bleeding. Among them, 15 (37.5%) died, and among those, 3 (2.3%) were related to re-bleeding. Multivariate analysis revealed that duodenal bleeding (odds ratio [OR] 3.305; 95% confidence interval [CI] 1.152-9.479, p = 0.026) and Charlson comorbidity index score (CCI) (OR 1.22; 95% CI 1.052-1.419, p = 0.009) were significant risk factors for re-bleeding. Index albumin levels (OR 0.134; 95% CI 0.035-0.506, p = 0.003), previous PU or upper gastrointestinal bleeding (UGIB) history (OR 4.626; 95% CI 1.375-15.567, p = 0.013), and CCI (OR 1.293; 95% CI 1.058-1.581, p = 0.012) were related all-cause mortality.CONCLUSION:
CCI and duodenal bleeding are risk factors for re-bleeding in patients with NVUGIB who were receiving OACs, while low index albumin levels and previous PU and UGIB history are associated with all-cause mortality.
While taking oral anticoagulants can offer various benefits, the risks of re-bleeding and all-cause mortality remain.A Charlson comorbidity index of higher than 4.5 and duodenal bleeding occurring while receiving oral anticoagulants increase the risk of rebleeding.Hypoalbuminemia <3.25 g/dL, history of peptic ulcer or upper gastrointestinal bleeding and Charlson comorbidity index were significant risk factors for all-cause mortality.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hemorragia Gastrointestinal
/
Anticoagulantes
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Limite:
Humans
/
Male
Idioma:
En
Revista:
Ann Med
Assunto da revista:
MEDICINA
Ano de publicação:
2023
Tipo de documento:
Article