Aspirin Has a Protective Effect Against Adverse Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding.
OBJECTIVE
To determine the effect of aspirin and anticoagulants on clinical outcomes and cause of in-hospital death in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB).


METHODS
Patients were identified from a tertiary center database that included all patients with UGIB. Clinical outcomes including (1) in-hospital mortality, (2) severe bleeding, (3) rebleeding, (4) in-hospital complications, and (5) length of hospital stay were examined in patients taking (a) aspirin only, (b) anticoagulants only, and (c) no antithrombotics.


RESULTS
Of 717 patients with NVUGIB, 56 % (402) were taking at least one antithrombotic agent. Seventy-eight (11 %) patients died in hospital, and 310 (43 %) had severe bleeding (BP < 90 mmHg, HR > 120 b/min, Hb < 7 g/dL on presentation, or transfusion of >3 units). On multivariate analysis, being on aspirin was protective against in-hospital mortality [OR 0.26 (0.13-0.53)], rebleeding [OR 0.31 (0.17-0.59)], and predictive of a shorter hospital stay (coefficient = -4.2 days; 95 % CI -8.7, 0.3). Similarly, being on nonaspirin antiplatelets was protective against in-hospital mortality (P = 0.03). However, being on anticoagulants was predictive of in-hospital complications [OR 2.0 (1.20-3.35)] and severe bleeding [OR 1.69 (1.02-2.82)]. Compared to those not taking any antithrombotics, patients who bled on aspirin were less likely to die in hospital of uncontrolled gastrointestinal bleeding (3.6 vs 0 %, P ≤ 0.01) and systemic cancer (4.9 vs 0 %, P ≤ 0.002), but equally likely to die of cardiovascular/thromboembolic disease, sepsis, and multiorgan failure.


CONCLUSIONS
Patients who present with NVUGIB on aspirin had reduced in-hospital mortality and fewer adverse outcomes, while those on anticoagulants had increased in-hospital complications.
Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon, awehbeh@emory.edu.
Antonios
A
Wehbeh
Hani M
HM
Tamim
Hussein
H
Abu Daya
Rachel
R
Abou Mrad
Rami J
RJ
Badreddine
Mohamad A
MA
Eloubeidi
Don C
DC
Rockey
Kassem
K
Barada
D000328:Adult; D000368:Aged; D000375:Aging; D001241:Aspirin / Q000494:pharmacology*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D041742:Upper Gastrointestinal Tract / Q000473:pathology*
D005343:Fibrinolytic Agents; D001241:Aspirin