A New Score for Predicting Acute Gastrointestinal Bleeding in Patients Administered Oral Antiplatelet Drugs.

Meina Lv,Xiaochun Zheng,Tingting Wu,Shaojun Jiang,Wenjun Chen,Jinhua Zhang,Fangda Xu,Hongqin Zhang

doi:10.3389/fphar.2020.571605

Abstract

Antiplatelet drugs may increase the risk of gastrointestinal bleeding. Currently, there is no specific score for predicting the risk of gastrointestinal bleeding caused by oral antiplatelet drugs. In this study, the gastrointestinal bleeding risk score was established and compared with the CRUSADE score in order to reduce the occurrence of clinical gastrointestinal bleeding events. Our study included 4052 patients who received oral antiplatelet drugs. Data were obtained from the patient medical records inpatient system. Cases of acute gastrointestinal bleeding and mortality were recorded. The bleeding score was established by logistic regression, area under the receiver operating characteristic curve, and the Hosmer–Lemeshow test. Finally, 171 patients had acute gastrointestinal bleeding. The mortality rates of patients in the bleeding and nonbleeding groups were 24.6 and 4.7%, respectively. A multivariate analysis revealed that an age of >65 years, anemia, recent major bleeding, a history of gastrointestinal bleeding, combined oral anticoagulants, and dual antiplatelet therapy are risk factors, and combined proton pump inhibitors are protective factors for acute gastrointestinal bleeding. We used these risk factors to establish a score for predicting acute gastrointestinal bleeding, named (ABC)2D score. The area under the curve for (ABC)2D score was 0.857 (p < 0.001), higher than the CRUSADE score of 0.693 (p < 0.001). The Hosmer–Lemeshow p value was 0.324. We developed the (ABC)2D score based on seven risk factors (i.e., age, anemia, recent major bleeding, a history of gastrointestinal bleeding, no-proton pump inhibitors use, combined oral anticoagulants, and dual antiplatelet therapy). (ABC)2D score was superior to the CRUSADE score. This new risk-scoring model may help to identify patients at a significant risk of gastrointestinal bleeding.

Highlights

Antiplatelet drugs are the cornerstone of cardiovascular disease prevention and treatment worldwide (Sostres et al, 2019)
Given the widespread use of antiplatelet therapy and the serious consequences of bleeding events, it is important to predict the risk factors for gastrointestinal bleeding associated with antiplatelet drugs and to construct a risk score
Through univariate and multivariate analyses, it was found that an age of >65 years, anemia, recent major bleeding, a history of gastrointestinal bleeding, combined use of oral anticoagulants, and dual antiplatelet therapy increased the risk of gastrointestinal bleeding, while combined use of proton pump inhibitors reduced the risk of gastrointestinal bleeding

Summary

Introduction

Antiplatelet drugs are the cornerstone of cardiovascular disease prevention and treatment worldwide (Sostres et al, 2019). Antiplatelet drugs successfully reduce the risk of recurrent ischemic events, they increase the risk of severe bleeding (Antithrombotic Trialists’ Collaboration et al, 2009; Li et al, 2017), of which gastrointestinal bleeding is common (Yamada et al, 2012). In order to prevent and reduce the risk of gastrointestinal bleeding, it is important to use risk models for acute prediction before patients receive antiplatelet drug treatment. Given the widespread use of antiplatelet therapy and the serious consequences of bleeding events, it is important to predict the risk factors for gastrointestinal bleeding associated with antiplatelet drugs and to construct a risk score. There is currently no specific score for predicting the risk of gastrointestinal bleeding caused by oral antiplatelet drugs

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