Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy.

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.