Saudi journal of medicine & medical sciences · 2025
Gastrointestinal Hemorrhage in Patients Receiving Antithrombotic Therapy: Clinical Patterns and Prognosis from Two Tertiary Care Hospitals.
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AlGhamdi Hamdan S, Koshan Mohammed A, AlOtaibi Nasser F, AlOtaibi Fahad M, AlSubaie Faisal F, Ekhuraidah Hussain A, Al Zahrani Rayan H, AlLehibi Abed A, AlGazlan Najd S, Aljumah Abdulrahman A
Аннотация
OBJECTIVES: To evaluate clinical patterns and prognosis of gastrointestinal hemorrhage (GIH) in patients on antithrombotic therapy (AT).
MATERIALS AND METHODS: This retrospective study included patients hospitalized with GIH between January 2010 and January 2020 at two tertiary care centers in Riyadh, Saudi Arabia. Demographics, clinical/laboratory/endoscopic findings, and outcomes were analyzed.
RESULTS: The study included 759 GIH patients: 354 AT users and 405 non-users. AT users were older (69.2 ± 13.9 vs 59.7 ± 17.1 years; P < 0.0001) with more cardiovascular comorbidities: hypertension (72.0% vs 38.5%), diabetes (63.3% vs 31.4%), ischemic heart disease (28.0% vs 4.7%), and stroke (15.0% vs 3.0%) (for all, P < 0.0001). Endoscopy showed AT users had higher erosive gastritis (19.2% vs 10.4%; P = 0.001) and colonic ulcers (9.9% vs 5.7%; P = 0.029), while non-users had more esophageal varices (24.4% vs 12.4%; P < 0.0001) and hemorrhoids (25.9% vs 16.4%; P = 0.001). AT users required more transfusions (1.43 ± 2.5 vs. 0.95 ± 1.8 units; P = 0.005), had lower hemoglobin (98.9 ± 29.1 vs. 105.7 ± 30.9 g/L; P = 0.002), higher creatinine (137.89 ± 138.5 vs. 111.3 ± 136.3 µmol/L; P = 0.011), more ICU admissions (28.5% vs. 19.0%; P = 0.002), and higher mortality (15.8% vs. 8.9%; P = 0.042). Independent predictors of mortality were AT (adjusted odds ratio [aOR]: 2.067, 95% CI: 1.102-3.879; P = 0.024), alongside liver cirrhosis (aOR: 2.573, 95% CI: 1.26-5.252; P = 0.009), malignancy (aOR: 2.836, 95% CI: 1.481-5.431; P = 0.002), transfusions (aOR: 1.246, 95% CI: 1.141-1.361; P < 0.001), and serum urea (aOR: 1.037; 95% CI: 1.017-1.057; P < 0.001).
CONCLUSION: Patients on antithrombotic therapy with gastrointestinal hemorrhage present with distinct risk profiles, severe anemia/renal impairment, higher resource utilization, and significantly increased mortality. These high-risk patients require careful management to improve their clinical outcomes.
MATERIALS AND METHODS: This retrospective study included patients hospitalized with GIH between January 2010 and January 2020 at two tertiary care centers in Riyadh, Saudi Arabia. Demographics, clinical/laboratory/endoscopic findings, and outcomes were analyzed.
RESULTS: The study included 759 GIH patients: 354 AT users and 405 non-users. AT users were older (69.2 ± 13.9 vs 59.7 ± 17.1 years; P < 0.0001) with more cardiovascular comorbidities: hypertension (72.0% vs 38.5%), diabetes (63.3% vs 31.4%), ischemic heart disease (28.0% vs 4.7%), and stroke (15.0% vs 3.0%) (for all, P < 0.0001). Endoscopy showed AT users had higher erosive gastritis (19.2% vs 10.4%; P = 0.001) and colonic ulcers (9.9% vs 5.7%; P = 0.029), while non-users had more esophageal varices (24.4% vs 12.4%; P < 0.0001) and hemorrhoids (25.9% vs 16.4%; P = 0.001). AT users required more transfusions (1.43 ± 2.5 vs. 0.95 ± 1.8 units; P = 0.005), had lower hemoglobin (98.9 ± 29.1 vs. 105.7 ± 30.9 g/L; P = 0.002), higher creatinine (137.89 ± 138.5 vs. 111.3 ± 136.3 µmol/L; P = 0.011), more ICU admissions (28.5% vs. 19.0%; P = 0.002), and higher mortality (15.8% vs. 8.9%; P = 0.042). Independent predictors of mortality were AT (adjusted odds ratio [aOR]: 2.067, 95% CI: 1.102-3.879; P = 0.024), alongside liver cirrhosis (aOR: 2.573, 95% CI: 1.26-5.252; P = 0.009), malignancy (aOR: 2.836, 95% CI: 1.481-5.431; P = 0.002), transfusions (aOR: 1.246, 95% CI: 1.141-1.361; P < 0.001), and serum urea (aOR: 1.037; 95% CI: 1.017-1.057; P < 0.001).
CONCLUSION: Patients on antithrombotic therapy with gastrointestinal hemorrhage present with distinct risk profiles, severe anemia/renal impairment, higher resource utilization, and significantly increased mortality. These high-risk patients require careful management to improve their clinical outcomes.