title: Gastrointestinal bleeding in acute ischemic stroke: recent trends from the fukuoka stroke registry.
abstract: BACKGROUND
  Gastrointestinal (GI) hemorrhage is a potentially serious complication of acute stroke, but its incidence appears to be decreasing. The aim of this study was to elucidate the etiology of GI bleeding and its impact on clinical outcomes in patients with acute ischemic stroke in recent years.
  
  
  METHODS
  Using the database of the Fukuoka Stroke Registry, 6,529 patients with acute ischemic stroke registered between June 2007 and December 2012 were included in this study. We recorded clinical data including any previous history of peptic ulcer, prestroke drug history including the use of antiplatelets, anticoagulants, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), and poststroke treatment with suppressing gastric acidity. GI bleeding was defined as any episode of hematemesis or melena on admission or during hospitalization. The cause and origin of bleeding were diagnosed endoscopically. Logistic regression analysis was used to identify risk factors for GI bleeding and its influence on deteriorating neurologic function, death, and poor outcome.
  
  
  RESULTS
  GI bleeding occurred in 89 patients (1.4%) under the condition that 66% of the total patients received acid-suppressing agents after admission. Multivariate analysis revealed that GI bleeding was associated with the absence of dyslipidemia (p = 0.03), a previous history of peptic ulcer (p < 0.001), and the severity of baseline neurologic deficit (p = 0.002) but not with antiplatelet drugs, anticoagulants, and NSAIDs. The source was the upper GI tract in 51% of the cases; causes included peptic ulceration (28%) and malignancies (12%), and other or unidentified causes accounted for 60%. GI bleeding mostly occurred within 1 week after stroke onset. Hemoglobin concentration fell by a median value of 2.5 g/dl in patients with GI bleeding. Among them, 28 patients underwent blood transfusion (31.5%). After adjustment for confounding factors, GI bleeding was independently associated with neurologic deterioration (OR 3.9, 95% CI 2.3-6.6, p < 0.001), in-hospital death (OR 6.1, 95% CI 3.1-12.1, p < 0.001), and poor outcome at 3 months (OR 6.8, 95% CI 3.7-12.7, p < 0.001). These associations were significant irrespective of whether patients underwent red blood cell transfusion.
  
  
  CONCLUSIONS
  GI bleeding infrequently occurred in patients with acute ischemic stroke, which was mostly due to etiologies other than peptic ulcer. GI bleeding was associated with poor clinical outcomes including neurologic deterioration, in-hospital mortality, and poor functional outcome.
authors.affiliation: Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan ; Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ogata
authors.affiliation: Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kamouchi
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Matsuo
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kuroda
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ago
authors.affiliation: Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugimori
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
keywords: Gastrointestinal bleeding; Ischemic stroke; Outcome