The Effect of Dual Antiplatelet Therapy on the Severity of Lower Intestinal Bleeding

Abstract

Introduction: The goal of our study was to identify the major variables predicting a poor outcome in patients with lower intestinal bleeding (LIB). The primary outcome observed was severe LIB, defined in previous clinical studies as continued bleeding in the first 24 hours of admission requiring transfusion of 2 or more units of blood and/or hematocrit decrease of 20% or more, recurrent bleeding after 24 hours of stability or readmission for LIB within 1 week of discharge. Surgical intervention and death directly related to LIB were recorded as secondary outcomes. An additional goal was to identify patients with LIB who were at high risk for developing severe bleeding with the use of dual anti platelet therapy. Risk stratification is an important tool to guide the intensity of management including the need for urgent intervention (e.g. colonoscopy, surgery, or angiogram). Methods: Retrospective chart and electronic records review of patients who were admitted after presenting to the emergency department with the chief complaint of LIB between January 1, 2008 and January 1, 2012. Results: Of 512 patients admitted for signs and symptoms of lower intestinal bleeding, 37.6% were determined to have severe bleeding by defined standards. A multivariate regression model was applied to identify specific potential risk factors for severe lower GI bleeding. The use of dual anti-platelet therapy (aspirin and clopidogrel) at the time of presentation in 4.8% of subjects was not shown to be a statistically significant risk factor for severe bleeding with a odds ratio of .566 95% confidence interval:0.205-1.559; p=0.271. Conclusion: Lower intestinal bleeding is a relatively common occurrence presenting significant burden to both patients and clinicians. It is important to understand the functional variables that effect patient outcomes and healthcare delivery. Our data demonstrates that dual anti-platelet therapy with aspirin and clopidogrel does not significantly increase the risk of severe lower intestinal bleeding episodes or other poor outcomes.Table 1: LIB Varriable Risk Analysis