Abstract
Objective To assess the treatment of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) in Chinese patients on antithrombotic therapy. Methods The clinical data of patients with ANVUGIB who underwent upper gastrointestinal endoscopy 24 h after bleeding at Beijing Anzhen Hospital, Capital Medical University, from 2016 to 2018, were analyzed retrospectively. The patients were divided into antithrombotic therapy and control groups and into high-risk (Forrest Ia, Ib, IIa, and IIb) and low-risk (Forrest IIc and III) bleeding groups according to the results of endoscopy. Results In all, 230 patients were enrolled, with 99 cases in the antithrombotic group (antiplatelet therapy 80 patients, anticoagulant therapy 19 patients) and 131 cases in the control group (without antithrombotic therapy). A total of 78 and 21 and 84 and 47 patients were at high- and low- risk for bleeding (P = 0.019) in the antithrombotic and control groups, respectively; 12.1% and 4.6% had esophageal bleeding (P = 0.047), and 8 and 2 patients received interventional therapy (P = 0.021). Overall, 21 patients with hemodynamic instability were treated via endoscopy with anesthesia under tracheal intubation and ventilator support: 20 patients in the antithrombotic group (13 patients within 1 month after coronary intervention, 5 patients within 1 month of cardiac-valve replacement, and 2 patients within 4 years of cardiac-valve replacement) and 1 patient with third-degree atrioventricular block in the control group. Ten patients received interventional therapy: eight and two in the two groups, respectively. Multidisciplinary consultation was conducted to regulate the use of antithrombotic drugs. Conclusion Compared to the controls, patients in the antithrombotic group had a significantly higher incidence of critical and active bleeding. Patients with hemodynamic instability should be examined and treated via upper gastrointestinal endoscopy under anesthesia with tracheal intubation and ventilator support.
Highlights
The incidence of cardiovascular and cerebrovascular diseases has increased due to the aging of the population; an increasing number of patients will need antithrombotic therapy
The sex distribution of the two groups was similar, while the mean age of patients was significantly older in the antithrombotic group than in the control group, and the proportion of patients on proton pump inhibitor (PPI) was significantly higher in the antithrombotic group than in the control group prior the bleeding occurring (Table 1)
A total of 21 patients with hemodynamic instability were treated via endoscopy with anesthesia under tracheal intubation and ventilator support: 20 patients in the antithrombotic group (13 patients within 1 month after coronary intervention, 5 patients within 1 month of cardiac-valve replacement, and 2 patients within 4 years of cardiac-valve replacement) and 1 patient with third-degree atrioventricular block in the control group
Summary
The incidence of cardiovascular and cerebrovascular diseases has increased due to the aging of the population; an increasing number of patients will need antithrombotic therapy. Antithrombotic therapy reduces the incidence of thrombotic events but significantly increases the risk for bleeding. Discontinuation of antithrombotic drugs after bleeding can significantly increase the risk of embolization [1,2,3]. Gastrointestinal bleeding may account for 54.9% of all bleeding events related to antithrombotic therapy [2]. There are no special Chinese consensus guidelines on how to perform endoscopy in antithrombotic patients with hemodynamic instability or when to discontinue or restore antithrombotic therapy after gastrointestinal bleeding, in patients who need to continue antithrombotic therapy. We retrospectively analyzed the clinical data of patients with acute nonvariceal upper gastrointestinal bleeding (ANVGIB) on antithrombotic therapy at Beijing Anzhen Hospital from 2016 and 2018 to provide reference information for the treatment of such patients
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