title: Long-term prognosis in patients continuing taking antithrombotics after peptic ulcer bleeding.
abstract: OBJECTIVE
  To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis.
  
  
  METHODS
  All clinical data of peptic ulcer patients treated from January 1, 2009 to January 1, 2014 were retrospectively collected and analyzed. Patients were divided into either a continuing group to continue taking antithrombotic drugs after ulcer bleeding or a discontinuing group to discontinue antithrombotic drugs. The primary outcome of follow-up in peptic ulcer bleeding patients was recurrent bleeding, and secondary outcome was death or acute cardiovascular disease occurrence. The final date of follow-up was December 31, 2014. Basic demographic data, complications, and disease classifications were analyzed and compared byt- or χ2-test. The number of patients that achieved various outcomes was counted and analyzed statistically. A survival curve was drawn using the Kaplan-Meier method, and the difference was compared using the log-rank test. COX regression multivariate analysis was applied to analyze risk factors for the prognosis of peptic ulcer patients.
  
  
  RESULTS
  A total of 167 patients were enrolled into this study. As for the baseline information, differences in age, smoking, alcohol abuse, and acute cardiovascular diseases were statistically significant between the continuing and discontinuing groups (70.8 ± 11.4vs62.4 ± 12.0,P< 0.001; 8 (8.2%)vs15 (21.7%),P< 0.05; 65 (66.3%)vs13 (18.8%),P< 0.001). At the end of the study, 18 patients had recurrent bleeding and three patients died or had acute cardiovascular disease in the continuing group, while four patients had recurrent bleeding and 15 patients died or had acute cardiovascular disease in the discontinuing group. The differences in these results were statistically significant (P= 0.022,P= 0.000). The Kaplan-Meier survival curve indicated that the incidence of recurrent bleeding was higher in patients in the continuing group, and the risk of death and developing acute cardiovascular disease was higher in patients in the discontinuing group (log-rank test,P= 0.000 for both). Furthermore, COX regression multivariate analysis revealed that the hazard ratio (HR) for recurrent bleeding was 2.986 (95%CI: 067-8.356,P= 0.015) in the continuing group, while HR for death or acute cardiovascular disease was 5.216 (95%CI: 1.035-26.278,P= 0.028).
  
  
  CONCLUSIONS
  After the occurrence of peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding.
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Xi-Xu
authors.initials: XX
authors.lastname: Wang
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Dong
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Hong
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Gong
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China.
authors.forename: Wei-Jun
authors.initials: WJ
authors.lastname: Jiang
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotics; Cardiovascular disease; Peptic ulcer bleeding; Risk factor; Survival curve