Introduction
Gastrointestinal (GI) hemorrhage remains the most common emergency in digestive endoscopy. However, its management is often tricky given the different etiopathogenic and clinical profiles associated with it. There is a tendency to believe that GI bleeding is often more detrimental in patients on anti-platelet aggregation and/or anticoagulation because of the altered physiological hemostasis and the risk of flare-up of the underlying disease justifying their use.
Aims & Methods
The aim of our study was to investigate the epidemiological, clinical profile and outcomes of gastrointestinal bleeding occurring in this particular context. We conducted a retrospective comparative study including patients hospitalized for GI bleeding between 2015 and 2023. Patients were divided into two groups according to whether they were on antithrombotic therapy (platelet and/or oral anticoagulation) (G1) or not (G2). We have excluded patients with portal hypertension related bleeding and patients with inherited blood disorders. Clinico-biological, therapeutic data and outcomes were collected and compared between the two groups.
Results
Of the 91 patients enrolled with a sex-ratio of 1.84, 52 were on anti-platelet agents and/or oral anticoagulants. The mean age was significantly higher in patients under anti-thrombotic treatment (G1: 70 vs G2: 56 years, p<0.0001). The two groups were comparable in terms of gender, systolic blood pressure, hemoglobin levels. However, G1 patient showed higher levels of CRP (G1: 38.8 vs G2: 25.86 mg/dl, p=0.04) and plasma urea (G1: 12,8 vs G2: 9,3 mmol/l, p=0.02). The main cause of bleeding in both groups was peptic ulcer disease. Nevertheless, lower GI bleeding was significantly more frequent in the first group (p=0.03), with the main etiology in this context being diverticular hemorrhage (p=0.01). There was no significant difference in the number of red blood cells (RBCs) transfused, the time taken to perform GI endoscopy, the use of a particular endoscopic hemostasis technique and the number of sessions required to control the bleeding between the two groups. Patients under anti-thrombotic therapy were significantly more likely to be explored by colonoscopy (p=0.01), to have longer mean hospital stay (G1: 8 vs G2: 5 days, p=0.03), without any increase in hemodynamic disorders or infectious complications. Similarly, there was no increase in the need for catecholamines, intensive care unit admission or in mortality rates noted in G1 patients (p >0.05). Finally, the rate of distant bleeding recurrence was slightly similar in the two groups (G1: 13,4 vs G2: 17,9 %, p> 0.05)
Conclusion
Although the occurrence of digestive bleeding is a severe adverse event in patients undergoing antithrombotic therapy due to a precarious underlying condition, there were no major differences regarding outcomes when compared with patients without anti-thrombotic therapy. This reflects a better knowledge of the guidelines regulating the use of these drugs with a better assessment of the bleeding/clotting balance and the improvement of endoscopic hemostasis management.