Mo1730 CONTINUOUS ADMINISTRATION OF ANTITHROMBOTIC DRUGS DOES NOT EXACERBATE ACUTE LOWER GASTROINTESTINAL BLEEDING: POST-HOC ANALYSIS OF A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Abstract

Currently, there is no established guideline for the continue or discontinue of antithrombotic drugs such as antiplatelet drugs and anticoagulants for patients with gastrointestinal bleeding. Previous retrospective reports suggest that the continuation of antithrombotic drugs increase the risk of early rebleeding. However, discontinuation of antithrombotic drugs has been suggested as a possibility of increased cerebrocardiovascular events and mortality. We conducted a multicenter randomized controlled trial (RCT) on the usefulness of early colonoscopy for acute lower gastrointestinal bleeding (ALGIB) in collaboration with 14 facilities. In the present study, we compared the effects of continuation and discontinuation of antithrombotic drugs for ALGIB as a post-hoc analysis of the RCT. Among 162 patients who visited the hospital for ALGIB between June 2016 and May 2018, 87 were taking antithrombotic drugs. We divided the patients into antithrombotic drugs continuation (n=55) and discontinuation (n=32) groups when they underwent colonoscopy. As a post-hoc analysis, the early rebleeding rate (within 30 days), blood transfusion, the stigmata of recent hemorrhage (SRH) identification rate, additional treatment (endoscopy, interventional radiology, surgery), and adverse events (thrombosis and mortality) were compared between the two groups. Student’s t-test was used for continuous variables, and chi-square test was used for categorical variables. Mantel-Haenszel analysis was performed by adjusting facilities and operators. There was no difference in the type of antithrombotic drugs and bleeding source in the patient background. The early rebleeding rate was not significantly different between the continuation (14.5%) and discontinuation groups (3.1%) (P = 0.14, 95% confidence interval [CI]: -22.1% to -10.3%). The SRH identification rate was not significantly different between the continuation (23.6%) and discontinuation groups (25.0%) (P = 0.98, 95% CI: -19.5% to -19.1%). Blood transfusion, additional treatment such as endoscopic hemostasis or surgery or interventional radiology was not significantly different in either group. No mortality or thrombosis occurred in either group within the 30-day observation period. Reports regarding the continuation of antithrombotic drugs and the course of bleeding such as early rebleeding and blood transfusion were rare. Furthermore, the use of patient data from multicenter RCT is novel. Continuous administration of antithrombotic drugs did not exacerbate ALGIB. This suggests that colonoscopy with continued antithrombotic drug administration should be considered.