| Popis: |
Background There is a widespread use of antithrombotic (AT) medications in primary and secondary prevention of cardiovascular disease in recent years, particularly since the introduction of direct oral anticoagulants (DOACs). The aim of our study is to determine clinical predictors of adverse outcome in patients with non-variceal upper GI bleeding comparing the patients who were on AT drugs to those who were not any. Methods All patients admitted to the bleeding unit with a primary diagnosis of upper GI bleeding between 01/05/2015 to 15/09/2017 were identified. Variceal bleedings were excluded in this study. Patients’ demographics, AT prescriptions, co-morbidities, admission time and blood results on the day of admission were collected. Outcomes of the study included 30-day mortality, endoscopic therapy, blood transfusion, re-bleeding (from the same admission) and duration of hospital stay. The relationship between the variables and clinical outcomes were examined. Results 291 patients (Median age: 71, IQR: 59–81, male: 66.7%) were analysed and peptic ulcer bleeding was the commonest cause of bleeding (56.7%). 94% of endoscopies were performed within 24 hours of admission. Endoscopic treatment and blood transfusion were required in 49% and 59% respectively, whilst 13% of cases required further radiological/surgical interventions. Re-bleeding rate was 7.5%, medial length of stay was 6 days (IQR 4–11), and all-cause mortality rate was 8.9%. The number of patients on NSAIDs/Aspirin, Clopidogrel/Ticagrelor, Warfarin, and DOACs were 99, 26, 33, and 16 respectively. There was no statistically significant difference in all clinical outcomes in patients on ATs versus those not on any. After logistic regression analysis, raised C-reactive Protein (CRP, p=0.003) and co-morbidities (p=0.038) were significant predictors of 30-day mortality. Male gender (p=0.021) was a significant predictor of need for endoscopic treatment. Bleeding with a fall in haemoglobin (Hb, p Conclusion We found no significant difference in all clinical outcomes in patients on different ATs compared to patients who are not. Out-of-hours admissions did not have any significant influence on clinical outcomes either. |
