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Recent use of NSAID and NOAC medications are associated with a positive CT arteriogram

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Computed tomography angiography (CTA) is a diagnostic modality utilized in patients with suspected active lower gastrointestinal (GI) bleeding. CTA use in clinical practice is limited by the risk of contrast-induced nephropathy, and the loss of patients from direct physician observation while undergoing the test. Identifying clinical predictors of a positive result would be useful in guiding physician utilization of CTA studies.

Methods

We performed a single-center retrospective study to determine which clinical predictors are associated with a positive CTA. Binary logistical regression modeling was used to identify the independent predictors and the results were expressed as adjusted odds ratios with corresponding 95% CI .

Results

262 patients met inclusion criteria and there were 61 (23.3%) positive CTA exams. In unadjusted analysis those who were CTA positive were more likely to require management in the intensive care unit (85.2% vs. 14.8%, p < 0.01) and being CTA positive was associated with a significantly increased in-hospital mortality (14.8% vs. 4.5%, p < 0.01). The use of a novel oral anticoagulant (NOAC) in the week prior to presentation was associated with a positive CTA after adjustment for confounders (adjusted odds ratio = 3.89; 95% CI 1.05–14.43). Similarly, the use of a non-steroidal anti-inflammatory drug (NSAID) was associated with a positive CTA (OR 2.36; 1.03–5.41). Only 8% of patients experienced contrast-induced nephropathy.

Conclusion

Use of either NOACs or NSAIDs in the previous week is independently associated with a positive CTA in the setting of acute lower GI bleeding. CTA exams appear to confer a low risk of contrast-induced nephropathy.

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Abbreviations

CKD:

Chronic kidney disease

CIN:

Contrast-induced nephropathy

CTA:

Computed tomography angiography

GIB:

Gastrointestinal bleeding

LGIB:

Lower gastrointestinal bleeding

NOAC (DOAC):

Novel oral anticoagulant (direct oral anticoagulant)

NSAID:

Non-steroidal anti-inflammatory drug

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Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA, 19140, USA

    Muhammad A. Shafqet, Adam C. Ehrlich & Frank K. Friedenberg

  2. School of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Alexander Tonthat

  3. Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Paola Esparragoza & Butros Toro

Authors
  1. Muhammad A. Shafqet
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  2. Alexander Tonthat
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  3. Paola Esparragoza
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  5. Adam C. Ehrlich
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Correspondence to Frank K. Friedenberg.

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Shafqet, M.A., Tonthat, A., Esparragoza, P. et al. Recent use of NSAID and NOAC medications are associated with a positive CT arteriogram. Abdom Radiol 44, 2632–2638 (2019). https://doi.org/10.1007/s00261-019-02005-3

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  • DOI: https://doi.org/10.1007/s00261-019-02005-3

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