Iatrogeny as a Cofactor in Acute Lower Gastrointestinal Bleeding—A Prospective Study in Portugal Regional Hospitals

Abstract

ObjectivesTo determine the impact of the use of nonsteroidal anti-inflammatory, antiplatelet and anticoagulant agents in the severity and prognosis of acute lower gastrointestinal bleeding.Aims & MethodsA prospective multicenter study on acute lower gastrointestinal bleeding in Portugal Regional Hospitals for a year (May 2008 to April 2009).Results364 patients (51.6% male; mean age: 72 years) were included. 86.8% were outpatients at the onset of bleeding. The cause of bleeding was identified in 93.2% patients. The main endoscopic diagnoses were diverticulosis of the colon (39.3%), ischemic colitis(24.4%), colonic polyps (18.4%) and colorectal cancer (14%).197 patients (54.2%) were under at least one type of drug (35.2% antiplatelet, 15.4% nonsteroidal anti-inflammatory, 6.2% oral anticoagulant, 2.4% low molecular weight heparin and 1.1% unfractionated heparin). In this group blood pressure and hematocrit levels were lower (67.6 vs 70.7 mmHg, P = .044 and 32.8 vs 34.5%, P = .046) and in patients receiving heparin, the relative risk of rebleeding and mortality was 8 (P = .042) and 32 (P = .003) times higher in a multivariate analysis.ConclusionMore than half of the patients enrolled were taking at least one type of agent. In this subgroup there was a greater severity of bleeding which, in the case of heparin, was associated with higher rebleeding and mortality rates. ObjectivesTo determine the impact of the use of nonsteroidal anti-inflammatory, antiplatelet and anticoagulant agents in the severity and prognosis of acute lower gastrointestinal bleeding. To determine the impact of the use of nonsteroidal anti-inflammatory, antiplatelet and anticoagulant agents in the severity and prognosis of acute lower gastrointestinal bleeding. Aims & MethodsA prospective multicenter study on acute lower gastrointestinal bleeding in Portugal Regional Hospitals for a year (May 2008 to April 2009). A prospective multicenter study on acute lower gastrointestinal bleeding in Portugal Regional Hospitals for a year (May 2008 to April 2009). Results364 patients (51.6% male; mean age: 72 years) were included. 86.8% were outpatients at the onset of bleeding. The cause of bleeding was identified in 93.2% patients. The main endoscopic diagnoses were diverticulosis of the colon (39.3%), ischemic colitis(24.4%), colonic polyps (18.4%) and colorectal cancer (14%).197 patients (54.2%) were under at least one type of drug (35.2% antiplatelet, 15.4% nonsteroidal anti-inflammatory, 6.2% oral anticoagulant, 2.4% low molecular weight heparin and 1.1% unfractionated heparin). In this group blood pressure and hematocrit levels were lower (67.6 vs 70.7 mmHg, P = .044 and 32.8 vs 34.5%, P = .046) and in patients receiving heparin, the relative risk of rebleeding and mortality was 8 (P = .042) and 32 (P = .003) times higher in a multivariate analysis. 364 patients (51.6% male; mean age: 72 years) were included. 86.8% were outpatients at the onset of bleeding. The cause of bleeding was identified in 93.2% patients. The main endoscopic diagnoses were diverticulosis of the colon (39.3%), ischemic colitis(24.4%), colonic polyps (18.4%) and colorectal cancer (14%).197 patients (54.2%) were under at least one type of drug (35.2% antiplatelet, 15.4% nonsteroidal anti-inflammatory, 6.2% oral anticoagulant, 2.4% low molecular weight heparin and 1.1% unfractionated heparin). In this group blood pressure and hematocrit levels were lower (67.6 vs 70.7 mmHg, P = .044 and 32.8 vs 34.5%, P = .046) and in patients receiving heparin, the relative risk of rebleeding and mortality was 8 (P = .042) and 32 (P = .003) times higher in a multivariate analysis. ConclusionMore than half of the patients enrolled were taking at least one type of agent. In this subgroup there was a greater severity of bleeding which, in the case of heparin, was associated with higher rebleeding and mortality rates. More than half of the patients enrolled were taking at least one type of agent. In this subgroup there was a greater severity of bleeding which, in the case of heparin, was associated with higher rebleeding and mortality rates.