T1954 Pre-Endoscopic Proton Pump Inhibitors in Non-Variceal Upper Gastrointestinal Bleeding; Continuous Infusion vs. Bolus

Abstract

Aim: to evaluate the influence of anticoagulant therapy upon the course of non-variceal UGB. Methods: From January 2006 to Juny 2007 we carried out a cohort study of consecutive patients admitted in hospital due to UGB shown by haematemesis or melena. Upper gastrointestinal endoscopy was performed during the first 12 hours of admission. Three cohorts were defined: patients receiving vitamin K antagonists (AC), patient with antiplatelet treatment (AP) and patients without anticoagulant therapy (noACAP) as control group. The AC cohort was evaluated according to excess of anticoagulant treatment(INR>o<3). Outcome was assessed by: a) number of days in hospital; b) mortality rate; c) need for urgent surgery; and d) rebleeding. The measure of the association between antithrombotic therapy and the course of UGB was adjusted for confounders (age, sex, comorbidity, and the use of NSAIDs and PPIs at the time of UGB presentation). Other evaluated parameters were: etiology of UGB, initial hemodynamic severity, excess of anticoagulation, initial hemoglobin and blood transfusions. Results: A total of 392 consecutive patients were included. Forty-three were AC, 107 AP and 242 noACAP patients. In the AC cohort, 25 patients (58%) were overanticoagulated. The mean age was 64±19 years (64% men) and AC and AP patients were older than the controls. Significant comorbidity other than diabetes or hypertension was significantly greater in the AC cohort than in the noACAP cohort. Peptic lesions were more frequent in the AP cohort, and hemoglobin upon admission was lower in the AC cohort. There were no significant differences in terms of sex, previous use of PPIs, hemodynamic alterations, or number of units of packed red blood cells transfused. There were no significant differences among groups in terms of rebleeding (AC:11.6%. AP: 7.5%. NoACAP:9.1%), the need for urgent surgery (AC:2.3%. AP: 1.9%. NoACAP:1.2%) or mortality rate (AC:4.7%. AP:5.6%. NoACAP:5.8%). There were no differences in clinical outcome among overanticoagulated patients and the rest of them (INR<3). The number of days in hospital was greater in the AC cohort (4.81 more days; 95%CI 2.83-6.79, p<0.001). After adjusting for age and comorbidity, the increase in days in hospital among the AC patients was 3.24 days (95%CI: 1.22-5.26). CONCLUSION: Anticoagulated patients, including overanticoagulated patients, have similar clinical course that those without this treatment. Nevertheless, anticoagulation is associated with a longer hospital stay. This is partially explained by the older age and increased comorbidity of the patients subjected to such treatment.