Use of Antiplatelet Therapy Without Clear Medical Indications in Patients With Upper Gastrointestinal Bleeds

Introduction: Recent studies have shown increasing usage of antiplatelet medication to treat a variety of chronic conditions. Although these medications improve survival in certain conditions, antiplatelet agents increase the risk of upper GI bleeds (UGIBs). This study aimed to assess the prevalence of antiplatelet therapy and their medical indications in patients who had UGIBs at our institution. Methods: This retrospective cohort study recruited all patients from a single academic tertiary gastroenterology practice who received endoscopic treatment for upper GI bleeds during the years 2015-2022. Patients were identified using physician billing codes for endoscopic treatment for upper GI bleeds. Information regarding demographics, medications, and previous GI diagnoses were collected using endoscopy reports and medication records from the local hospital medical database. We documented antiplatelet medication status at time of endoscopic treatment for UGIB. We assessed medical indication for the antiplatelet therapy based on the Canadian Cardiovascular Society guidelines on antiplatelet therapy1. We analyzed the patient’s physician narrative reports for these conditions and the documented rationale for first prescribing the medication. Furthermore, we defined a recent medication prescription as any therapy that was initiated 3 months prior to the UGIB. All the information was coded using a standardized data sheet and entered into SPSS for data analysis. Results: Data were collected from 102 upper GI bleeds. The average patient age of the sample was 62.9 years old. The sample consisted of 70 males (68%) and 32 females (31%). In total, 27 patients were prescribed antiplatelet therapy at time of the UGIB. The most common medical indications for antiplatelet therapy were previous PCI with 33%, CABG with 15% and stroke with 11% (Table 1). Meanwhile, 30% of all patients prescribed antiplatelet therapy had no clear medical indication for therapy. 33% of patients began their antiplatelet therapy within 3 months of their UGIB. Conclusion: At the time of endoscopic treatment for upper GI bleed, a third of patients on antiplatelet medications had no clear medical indications. This may place patients at risk of UGIBs without gaining reciprocal benefits from therapy. Research at other centers involving compressive patient datasets can help further investigate this phenomenon. Resources: 1-https://pubmed.ncbi.nlm.nih.gov/21640290/ Table 1. - Medical Indications for Antiplatelet Therapy Medical Indications Number of Patients Percentage PCI 9 33.3 CABG 4 14.8 Stroke 3 11.1 ACS 2 7.4 No clear indication 8 29.6 Total 27 100.0 PCI (percutaneous coronary intervention), CABG (coronary artery bypass graft), ACS (acute coronary syndrome).