Improved Survival for Patients With Acute Upper Gastrointestinal Bleeding While on Antithrombotic Therapy A Multicenter Prospective Cohort Study

Goals:Aim of the study was to determine if patients with acute upper gastrointestinal bleeding (AUGIB) while on antithrombotic agents (ATs) are at higher risk for worse outcomes. Background:ATs are risk factors of AUGIB, but their impact on clinical outcomes is uncertain. Study:Patients with AUGIB (nonvariceal, NV-AUGIB or variceal, V-AUGIB) in 50 Italian hospitals were prospectively enrolled from January 1, 2014 to December 31, 2015. Clinical data, laboratory tests, comorbidities, prognostic scores, received therapies, and outcomes (death, rebleeding, surgery/radiology, transfusions, length of hospitalization) were analyzed. Results:A total of 3324 patients (2764 NV-AUGIB, 83.2% and 560 V-AUGIB, 16.8%) were enrolled, 1399 (42.1%) on ATs. Patients taking ATs were older (75.4 vs. 62.8 y, P<0.001), had higher American Society of Anesthesiologists (ASA), Rockall and Glasgow-Blatchford scores (P<0.001). At multivariate analysis considering comorbidities, ATs use resulted an independent protective factor against death [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.45-0.87, P=0.006]. Rebleeding (5.5% vs. 5.8%, P=0.71) and need for salvage surgery/radiology (4.2% vs. 4.8%, P=0.41) were similar in the 2 groups. Considering specific ATs, low-dose aspirin was the most powerful factor lowering the death risk (OR: 0.51, 95% CI: 0.33-0.81, P=0.004). While the generic use of AT therapy did not emerge as a statistically significant independent protective factor considering separately NV-AUGIB (OR: 0.80, 95% CI: 0.56-1.13, P=0.21) and V-AUGIB (OR: 0.40, 95% CI: 0.15-1.07, P=0.068), the protective effect of low-dose aspirin was confirmed for NV-AUGIB (OR: 0.62, 95% CI: 0.41-0.94, P=0.025). Conclusions:ATs use is an independent protective factor against death in AUGIB. The protective effect is mainly derived from low-dose aspirin.