Major gastrointestinal bleeding and antithrombotics: Characteristics and management  

作　　者：Jacques Bouget Damien Viglino Quentin Yvetot Emmanuel Oger 

机构地区：[1]EA 7449 REPERES,Pharmacoepidemiology and Health Services Research,Univ Rennes,Rennes 35000,France [2]Emergency Department and Mobile Intensive Care Unit-HP2 Laboratory INSERM U1042,University Grenoble Alps,La Tronche 38700,France [3]Emergency Department,CHU Rennes,Rennes 3500,France [4]EA 7449 REPERES,Universitéde Rennes 1,Rennes 35000,France

出　　处：《World Journal of Gastroenterology》2020年第36期5463-5473,共11页世界胃肠病学杂志（英文版）

基　　金：National Clinical Research Hospital Program of the French Ministry of Health,No.PHRC-12-009-0243.

摘　　要：BACKGROUND There are few reports on major gastrointestinal(GI)bleeding among patients receiving an antithrombotic.AIM To describe clinical characteristics,bleeding locations,management and inhospital mortality related to these events.METHODS Over a three-year period,we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1,2013 and December 31,2015 for major GI bleeding while receiving an antithrombotic.The bleeding events were medically validated.Clinical characteristics,causative lesions,management and fatalities were described.The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding.No cause was identified for 383(35.5%)patients.Gastro-duodenal ulcer was the first causative lesion in the upper tract(209 out of 408)and colonic diverticulum the first causative lesion in the lower tract(120 out of 289).There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations(P=0.03).There was an independent association between gastro-duodenal ulcer and antithrombotic use(P=0.03),taking account of confounders and proton pump inhibitor coprescription.Pair wise comparisons pointed to a difference between vitamin K antagonist,direct oral anticoagulants,and antiplatelet agents in monotherapy vs dual antiplatelet agents.CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding.Management was similar across antithrombotics and in-hospital mortality was low(5.95%).

关 键 词：Real-world setting EMERGENCY BLEEDING MORTALITY ANTITHROMBOTICS MANAGEMENT 

分 类 号：R57[医药卫生—消化系统]