title: Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding.
abstract: BACKGROUND
  Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/or anticoagulants and represents a clinical challenge in patients undergoing these therapies.
  
  
  OBJECTIVE
  To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes.
  
  
  METHODS
  Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012. The outcomes were compared between patients exposed and not exposed to antithrombotics.
  
  
  RESULTS
  Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years) were included, of which 43% received antithrombotics. Most patients had comorbidities. Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases. The 30-day mortality rate was 7.7% (n = 42), and 36% were bleeding-related. The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment. There were no significant differences between the exposed and non-exposed groups in most outcomes. Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL) and higher international normalized ratio (1.63 ± 1.13) were associated significantly with mortality in a univariate analysis.
  
  
  CONCLUSIONS
  Adverse outcomes were not associated with antithrombotic use. The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.
authors.affiliation: Centro Hospitalar do Porto, Porto, Portugal, Portugal.
authors.forename: Elvira
authors.initials: E
authors.lastname: Teles-Sampaio
authors.affiliation: Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Maia
authors.affiliation: Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Salgueiro
authors.affiliation: Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Marcos-Pinto
authors.affiliation: CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.affiliation: Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Pedroto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors