Digestive Diseases and Sciences

, Volume 60, Issue 7, pp 2077–2087 | Cite as

Aspirin Has a Protective Effect Against Adverse Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

  • Antonios Wehbeh
  • Hani M. Tamim
  • Hussein Abu Daya
  • Rachel Abou Mrad
  • Rami J. Badreddine
  • Mohamad A. Eloubeidi
  • Don C. Rockey
  • Kassem Barada
Original Article

Abstract

Objective

To determine the effect of aspirin and anticoagulants on clinical outcomes and cause of in-hospital death in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB).

Methods

Patients were identified from a tertiary center database that included all patients with UGIB. Clinical outcomes including (1) in-hospital mortality, (2) severe bleeding, (3) rebleeding, (4) in-hospital complications, and (5) length of hospital stay were examined in patients taking (a) aspirin only, (b) anticoagulants only, and (c) no antithrombotics.

Results

Of 717 patients with NVUGIB, 56 % (402) were taking at least one antithrombotic agent. Seventy-eight (11 %) patients died in hospital, and 310 (43 %) had severe bleeding (BP < 90 mmHg, HR > 120 b/min, Hb < 7 g/dL on presentation, or transfusion of >3 units). On multivariate analysis, being on aspirin was protective against in-hospital mortality [OR 0.26 (0.13–0.53)], rebleeding [OR 0.31 (0.17–0.59)], and predictive of a shorter hospital stay (coefficient = −4.2 days; 95 % CI −8.7, 0.3). Similarly, being on nonaspirin antiplatelets was protective against in-hospital mortality (P = 0.03). However, being on anticoagulants was predictive of in-hospital complications [OR 2.0 (1.20–3.35)] and severe bleeding [OR 1.69 (1.02–2.82)]. Compared to those not taking any antithrombotics, patients who bled on aspirin were less likely to die in hospital of uncontrolled gastrointestinal bleeding (3.6 vs 0 %, P ≤ 0.01) and systemic cancer (4.9 vs 0 %, P ≤ 0.002), but equally likely to die of cardiovascular/thromboembolic disease, sepsis, and multiorgan failure.

Conclusion

Patients who present with NVUGIB on aspirin had reduced in-hospital mortality and fewer adverse outcomes, while those on anticoagulants had increased in-hospital complications.

Keywords

Hemorrhage Aspirin Anticoagulant Outcome Morbidity Mortality 

Abbreviations

UGIB

Upper gastrointestinal bleeding

NVUGIB

Nonvariceal upper gastrointestinal bleeding

AC

Anticoagulant

AP

Antiplatelet

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Antonios Wehbeh
    • 1
  • Hani M. Tamim
    • 2
  • Hussein Abu Daya
    • 3
  • Rachel Abou Mrad
    • 1
  • Rami J. Badreddine
    • 1
  • Mohamad A. Eloubeidi
    • 1
  • Don C. Rockey
    • 4
  • Kassem Barada
    • 1
  1. 1.Division of Gastroenterology and HepatologyAmerican University of Beirut Medical CenterBeirutLebanon
  2. 2.Biostatistics Support Unit, Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
  3. 3.Department of Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Department of Internal MedicineThe Medical University of South CarolinaCharlestonUSA

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