Antithrombotic agents avert death in acute upper gastrointestinal bleeding

Use of antithrombotic agents (ATs) provides a protective benefit against death in patients with acute upper gastrointestinal bleeding (AUGIB), suggests a study, noting that low-dose aspirin is responsible for such protective effect.

The research team prospectively enrolled a total of 3,324 patients with AUGIB (2,764 [83.2 percent] nonvariceal [NV] and 560 [16.8 percent] variceal [V]) in 50 Italian hospital from 1 January 2014 to 31 December 2015. They analysed the participants’ clinical data, laboratory tests, comorbidities, prognostic scores, received therapies, and outcomes (ie, death, rebleeding, surgery/radiology, transfusions, and length of hospitalization).

Of the patients, 1,399 (42.1 percent) were on ATs. Most of those taking ATs were older (75.4 percent vs 62.8 percent; p<0.001) and had higher American Society of Anesthesiologists (ASA), Rockall and Glasgow-Blatchford scores (p<0.001).

Multivariate analysis that considered comorbidities revealed an independent protective effect by ATs against death (odds ratio [OR], 0.63, 95 percent confidence interval [CI], 0.45‒0.87; p=0.006). The two groups showed comparable rates of rebleeding (5.5 percent vs 5.8 percent; p=0.71) and need for salvage surgery/radiology (4.2 percent vs 4.8 percent; p=0.41).

In terms of specific ATs, low-dose aspirin appeared to be most effective at reducing the risk of death (OR, 0.51, 95 percent CI, 0.33‒0.81; p=0.004).

The independent protective factor of the generic use of AT therapy did not reach statistical significance when considering NV-AUGIB (OR, 0.80, 95 percent CI, 0.56‒1.13; p=0.21) and V-AUGIB (OR, 0.40, 95 percent CI, 0.15‒1.07; p=0.068) separately. However, the protective benefit with low-dose aspirin persisted for NV-AUGIB (OR, 0.62, 95 percent CI, 0.41‒0.94; p=0.025).