title: Antiplatelet agents do not impact the hospital course in patients with gastrointestinal bleeding.
abstract: BACKGROUND
  Use of antiplatelet agents (APAs) have been shown to increase the risk of gastrointestinal (GI) bleeding despite their cardiovascular benefits.
  
  
  OBJECTIVE
  To understand the impact of APAs, we assessed the outcomes in patients admitted with acute GI bleeding to our hospital. We hypothesized there is no difference among GI bleeders admitted to the hospital while bleeding on or off APAs.
  
  
  METHODS
  In an observational prospective cohort study, 104 sequential patients admitted with a diagnosis of GI bleeding were followed. Patients were classified as either on APA or not.
  
  
  RESULTS
  Thirty of 104 (29%) patients were on long-term aspirin and/or clopidogrel on admission and 5 were taking nonaspirin nonsteroidal anti-inflammatory drugs, total of 35 (34%). There was no difference between patients using APA and those not using APA with regard to admission hemoglobin, age, presentation, source of bleed, total number of units transfused, intensive care unit admission rates, and overall length of stay. There was, however, a significant difference in the presence of hemodynamic compromise on initial presentation, with a higher proportion of APA users being orthostatic (51.4% vs 26% in nonusers, with P=0.02, by Fisher exact test). Clopidogrel was safely restarted in high-risk patients with significant cardiac history.
  
  
  CONCLUSIONS
  This study demonstrated that APA use did not significantly alter the course or outcome in GI bleeders admitted to our institution during their hospital stay.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. drbijojohn@yahoo.com
authors.forename: Bijo K
authors.initials: BK
authors.lastname: John
authors.forename: Sushma
authors.initials: S
authors.lastname: Arramraju
authors.forename: Albert
authors.initials: A
authors.lastname: Shalomov
authors.forename: Cristina
authors.initials: C
authors.lastname: Sison
authors.forename: Moshe
authors.initials: M
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects*; D000077144:Clopidogrel; D015331:Cohort Studies; D004244:Dizziness; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin