Lower Gastrointestinal Bleeding in Patients with Coronary Artery Disease on Antithrombotics and Subsequent Mortality Risk.

Link to article at PubMed

Lower Gastrointestinal Bleeding in Patients with Coronary Artery Disease on Antithrombotics and Subsequent Mortality Risk.

J Gastroenterol Hepatol. 2017 Nov 20;:

Authors: Patel P, Nigam N, Sengupta N

Abstract
BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common complication for patients with coronary artery disease (CAD) due to use of antithrombotic medications. Limited data exists describing which patients are at increased risk for mortality.
AIM: To 1) determine whether patients on dual antiplatelet (DAPT) therapy or triple therapy are at higher risk of 90-day and 6-month mortality compared to patients on aspirin (ASA) alone and 2) evaluate risk factors for mortality in patients with CAD on antithrombotics hospitalized with LGIB.
METHODS: We conducted a retrospective cohort study of patients hospitalized with LGIB and CAD while on aspirin at a single academic medical center from 2007 to 2015. Patients were identified using a validated, machine-learning algorithm and classified by use of aspirin, DAPT or triple therapy. Univariate and multivariate Cox proportional hazards were used to determine mortality associated risk factors.
RESULTS: 716 patients were identified with LGIB and CAD. 472 (65.9%) patients were on aspirin monotherapy, 179 (25%) on aspirin and thienopyridine (DAPT), and 65 (9.1%) on aspirin, thienopyridine, and systemic anticoagulant (triple therapy). On univariate analysis, triple therapy use was associated with increased risk of 90-day (HR 3.12,95%CI 1.52-5.92,p=0.003) and 6-month (HR 2.46,95%CI 1.29-4.35,p=0.008) mortality. Holding anticoagulation was associated with higher mortality at 90-days (HR 2.30,95%CI 1.27-4.07,p=0.007). On multivariate analysis, after adjusting for confounding variables, use of triple therapy remained associated with higher 90-day mortality (HR 3.23,95%CI 1.56-6.16,p=0.003).
CONCLUSION: Triple therapy is associated with mortality on at 90 days and at 6 months post discharge.

PMID: 29156506 [PubMed - as supplied by publisher]

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