Dunne PDJ, et al. - Researchers probed into the effects of anti-thrombotic agents on the outcomes of patients with high-risk upper gastrointestinal bleeding (UGIB) at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015. Regardless of being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, subjects presenting with UGIB warranting endoscopic therapy and those who took anti-thrombotic drugs demonstrated lower mortality as a result of GI bleeding. They also displayed shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, in contrast with those not taking anti-thrombotic drugs.

Methods

• The design of this research was a prospective study.
• Eligible candidates included 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8 centers in North America, Asia, and Europe, from March 2014 through March 2015.
• Data was extracted that were recorded on the use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores.
• Data was analyzed in terms of co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality.

Results

• Data on the use of anti-thrombotic agents was available for 568; 253 of these patients (44%) used anti-thrombotic agents among 619 patients who required endoscopic therapy.
• In contrast with patients not taking anti-thrombotic agents, patients treated with anti-thrombotics appeared to be older (P < .001), had a higher mean American Society of Anesthesiologists classification score (P < .0001), had a higher mean Rockall score (P < .0001), a higher mean AIMS65 score (P < .0001), and more frequently bled from ulcers (P < .001).
• No variations were reported between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion.
• Findings illustrated lower all-cause mortality in patients who took anti-thrombotic drugs (11 deaths, 4%) than in patients who did not (37 deaths, 12%) (P=.002).
• This was attributed to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1%) than in patients who were not (19 deaths, 6%) (P=.003).
• It was determined that subjects taking anti-thrombotic drugs presented with mean hospital stays of 6.9 days (95%, CI 2-23 days) vs 7.9 days for non-users of anti-thrombotic agents (95% CI, 2-26 days) (P=.04).