Upper gastrointestinal bleeding in hospital inpatients: the role of antithrombotic drugs

Taha, A. S., Kelly, C., McCloskey, C., Craigen, T. and Angerson, W. J. (2014) Upper gastrointestinal bleeding in hospital inpatients: the role of antithrombotic drugs. Postgraduate Medical Journal, 90(1066), pp. 429-433. (doi: 10.1136/postgradmedj-2013-132231)

Abstract

Background: Critically ill patients are considered to be most at risk from developing non-variceal upper gastrointestinal bleeding (NVGIB) while in hospital. The increasing prescription of low-dose aspirin and other antithrombotic drugs for protection against thromboembolism to many patients admitted to hospital may increase the vulnerability of a wider group to NVGIB.<p></p> Objective: This study compares two groups of patients with NVGIB: group I, inpatients cared for outside the intensive care unit; and group II, patients admitted with this condition, while considering the use of antithrombotic drugs.<p></p> Methods: We identified all patients who developed NVGIB in the two calendar years between 2008 and 2009 and compared group I with group II while taking into account their clinical details including Rockall scores and drug usage.<p></p> Results: Compared with group II (n=274), group I (n=96) were older (median age of 77 years vs 68; p<0.001), had fewer males (45.8% vs 60.6%; p=0.016), higher prevalence of cardiovascular disease (52.1% vs 29.2%; p<0.001), more patients with complete Rockall score ≥3 (84.4% vs 66.7%; p=0.001) and more patients treated with aspirin or other antithrombotic drugs (64.6% vs 44.5%; p=0.001). After adjustment for age and sex, group I were still significantly more likely to be taking antithrombotic drugs than group II (OR (95% CIs), 2.15 (1.25 to 3.68); p=0.006). The endoscopic abnormalities in more than 80% of patients included erosive oesophagitis, gastric or duodenal ulcers or erosions.<p></p> Conclusions: Subjects who develop NVGIB as inpatients have higher Rockall scores are mainly older females with cardiovascular disease and using antithrombotic drugs. Secondary care clinicians should be mindful of this at-risk group of patients and consider giving them prophylactic antiulcer therapy.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kelly, Dr Claire and Angerson, Dr Wilson
• Authors: Taha, A. S., Kelly, C., McCloskey, C., Craigen, T., and Angerson, W. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Postgraduate Medical Journal
• Publisher: BMJ Publishing Group
• ISSN: 0032-5473
• ISSN (Online): 1469-0756