Gross Lower Gastrointestinal Bleeding in Patients on Anticoagulant and/or Antiplatelet TherapyEndoscopic Findings, Management, and Clinical Outcomes

摘要

Objectives: Gross gastrointestinal (GI) bleeding is a serious complication of anticoagulant/antiplatelet drug therapy. This study compares the frequencies of colorectal pathologies, endoscopic and resuscitative management measures, and clinical outcomes of patients hospitalized with lower GI bleeding (LGIB) while using anticoagulants/antiplatelets with those of patients not using them.Methods: A retrospective review of the records of 166 admissions for patients with gross LGIB over 12 years was conducted. The colonoscopic findings, management measures, and clinical outcomes were compared between 2 groups. Group A composed of 100 patients using any antiplatelet/anticoagulant, and group B 66 patients not using any such drugs. Independent t tests and %2 were used to test for association between taking antiplatelet/anticoagulant and other variables.Results: Patients in group A were older and had more comorbidities than patients in group B. Severe LGIB occurred in 55.1% and 35.4% in groups A and B, respectively (P = 0.01). Severity was not related to old age or the presence of comorbidities. A higher percentage of patients in group A had a hospital stay > 6 days (44% vs. 27.3%; P < 0.03), required blood transfusions (68% vs. 51.5%; p = 0.03), and had in-hospital complications (37% vs. 22.7%; P = 0.052). The most common source of bleeding was diverticulosis in both groups. Colorectal abnormalities were present in most patients; and in those using warfarin, colon cancer was common.Conclusions: Use of antiplatelets/anticoagulant drugs is an independent predictor of severe LGIB and is associated with adverse outcomes. Colonoscopy is required in patients who bleed while using such drugs.