Tamotsu Matsuhashi1, Sho Fukuda1, Tatsuya Mikami2, Tetsuya Tatsuta3, Takuto Hikichi4, Jun Nakamura4, Yasuhiko Abe5, Yusuke Onozato6, Waku Hatta7, Atsushi Masamune7, Motoki Ohyauchi8, Hirotaka Ito8, Norihiro Hanabata9, Yasumitsu Araki9, Takumi Yanagita10, Hidemichi Imamura10, Tsuyotoshi Tsuji11, Kae Sugawara11, Youhei Horikawa12, Shuichi Ohara13, Yutaka Kondo13, Takahiro Dohmen14, Katsunori Iijima1. 1. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan. 2. Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan. 3. Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan. 4. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan. 5. Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan. 6. Department of Gastroenterology, Faculty of Medicine, Yamagata University Hospital, Yamagata, Japan. 7. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan. 8. Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan. 9. Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan. 10. Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan. 11. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 12. Department of Gastroenterology, Hiraka General Hospital, Akita, Japan. 13. Department of Gastroenterology, Tohoku Rosai Hospital, Miyagi, Japan. 14. Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan.
Abstract
OBJECTS: Although anti-thrombotic use is recognized as a risk factor for upper gastrointestinal bleeding (UGIB), there has been no clear evidence that it worsens the outcomes after the bleeding. The aim of this study is to investigate the effects of anti-thrombotic agents on in-hospital mortality following UGIB. METHODS: Information on clinical parameters, including usage of anti-thrombotic agents, was retrospectively collected from consecutive patients with UGIB at 12 high-volume centers in Japan between 2011 and 2018. The all-cause in-hospital mortality rate was evaluated according to the usage of anti-thrombotic agents. RESULTS: Clinical data were collected from 2205 patients with endoscopically confirmed UGIB. Six hundred and forty-five (29.3%) patients used anti-thrombotic agents. The all-cause in-hospital mortality rate was 5.7% (125 deaths). After excluding 29 cases in which death occurred due to end-stage malignancy, 96 deaths (bleeding-related, n = 22 ; non-bleeding-related, n = 74) were considered "preventable." Overall, the "preventable" mortality rate in anti-thrombotic users was significantly higher than that in non-users (6.0% vs. 3.7%, P < 0.05). However, the "preventable" mortality of anti-thrombotic users showed a marked improvement over time; although the rate in users remained significantly higher than that in non-users until 2015 (7.3% vs. 4.2%, P < 0.05), after 2016, the difference was no longer statistically significant (4.8% vs. 3.5%). CONCLUSIONS: Although the usage of anti-thrombotic agents worsened the outcomes after UGIB, the situation has recently been improving. We speculate that the recent revision of the Japanese guidelines on the management of anti-thrombotic treatment after UGIB may have partly contributed to improving the survival of users of anti-thrombotic agents.
OBJECTS: Although anti-thrombotic use is recognized as a risk factor for upper gastrointestinal bleeding (UGIB), there has been no clear evidence that it worsens the outcomes after the bleeding. The aim of this study is to investigate the effects of anti-thrombotic agents on in-hospital mortality following UGIB. METHODS: Information on clinical parameters, including usage of anti-thrombotic agents, was retrospectively collected from consecutive patients with UGIB at 12 high-volume centers in Japan between 2011 and 2018. The all-cause in-hospital mortality rate was evaluated according to the usage of anti-thrombotic agents. RESULTS: Clinical data were collected from 2205 patients with endoscopically confirmed UGIB. Six hundred and forty-five (29.3%) patients used anti-thrombotic agents. The all-cause in-hospital mortality rate was 5.7% (125 deaths). After excluding 29 cases in which death occurred due to end-stage malignancy, 96 deaths (bleeding-related, n = 22 ; non-bleeding-related, n = 74) were considered "preventable." Overall, the "preventable" mortality rate in anti-thrombotic users was significantly higher than that in non-users (6.0% vs. 3.7%, P < 0.05). However, the "preventable" mortality of anti-thrombotic users showed a marked improvement over time; although the rate in users remained significantly higher than that in non-users until 2015 (7.3% vs. 4.2%, P < 0.05), after 2016, the difference was no longer statistically significant (4.8% vs. 3.5%). CONCLUSIONS: Although the usage of anti-thrombotic agents worsened the outcomes after UGIB, the situation has recently been improving. We speculate that the recent revision of the Japanese guidelines on the management of anti-thrombotic treatment after UGIB may have partly contributed to improving the survival of users of anti-thrombotic agents.