title: Opposing effects of aspirin and anticoagulants on morbidity and mortality in patients with upper gastrointestinal bleeding.
abstract: OBJECTIVE
  We aimed to determine the effect of antithrombotics on in-hospital mortality and morbidity in patients with peptic ulcer disease-related upper gastrointestinal bleeding (PUD-related UGIB).
  
  
  METHODS
  The study cohort was retrospectively selected from a tertiary center database of patients with PUD-related UGIB, defined as bleeding due to gastric or duodenal ulcers, or erosive duodenitis, gastritis or esophagitis. Outcomes were compared among patient groups based on their antithrombotic medications before admission. Patients on no antithrombotics served as controls. The composite adverse outcomes, in-hospital mortality, rebleeding and/or need for surgery were measured. Severe bleeding and in-hospital complications were also recorded.
  
  
  RESULTS
  Of 398 patients with PUD-related UGIB, 44.5% were on aspirin or anticoagulants only. The composite adverse outcome was most common in patients taking anticoagulants only (40.5%), intermediate in controls (23.1%) and least in those taking aspirin only (12.1%). On multivariate analysis, patients taking aspirin alone had a significantly lower risk of adverse outcome events (odds ratio [OR] 0.4, 95% CI 0.2-0.8) and a shorter length of hospital stay (regression coefficient = -3.4, 95% CI [-6.6, -0.6]). In contrast, taking anticoagulants was associated with a greater risk of adverse outcome events (OR 2.3, 95% CI 1.0-5.3), severe bleeding (OR 2.6, 95% CI 1.2-5.8) and in-hospital complications (OR 2.9, 95% CI 1.3-6.6).
  
  
  CONCLUSIONS
  Patients with PUB-related UGIB while taking aspirin had fewer adverse outcomes compared with those taking anticoagulants. Aspirin may have beneficial effects in this population.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hussein
authors.initials: H
authors.lastname: Abu Daya
authors.forename: Mohamad
authors.initials: M
authors.lastname: Eloubeidi
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Houssam
authors.initials: H
authors.lastname: Halawi
authors.forename: Ahmad H
authors.initials: AH
authors.lastname: Malli
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
authors.forename: Kassem
authors.initials: K
authors.lastname: Barada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: anticoagulant; gastrointestinal hemorrhage; morbidity; peptic ulcer hemorrhage; platelet aggregation inhibitor