CHARACTERISTICS OF PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING WITH ANTI-COAGULATION AGENT; FOCUSING ON REBLEEDING

Aims Acute upper gastrointestinal bleeding (UGIB) is a severe complication associated with oral anticoagulants. However, little is known about the risk factors of rebleeding among anticoagulant users with a history of UGIB. We aimed in this study to evaluate the risk factors of rebleeding after successful endoscopic hemostasis for UGI bleeding in patients taking oral anticoagulants

Methods Between July 2007 and July 2019, 68 patients with oral anticoagulants were hospitalized due to nonvariceal UGIB and followed up at a tertiary hospital. We retrospectively reviewed the clinical characteristics and compared them between patients with and without rebleeding.

Results The most common cause of UGIB was peptic ulcer in 46 patients (70.6%), followed by Dieulafoy’s lesion in 4 patients (20%), Mallory-Weiss syndrome, Advanced gastric cancer(3 patients 15% respectively). Rebleeding after hemostasis occurred in 16 patients (23.5%). There was no 30-day mortality among patients with rebleeding. Univariate analysis revealed that duodenal location (43.8 vs. 17.3%, p=0.044) and presence of major comorbidities (81.3 vs. 23.1%, p< 0.001) were significantly more frequent in rebleeding group. By multivariate analysis, major comorbidities (odds ratio [OR] 43.8; 95% confidence interval [CI]; p< 0.001 5.1~378.0), duodenal location (OR 6.9; 95% CI; p=0.044 1.1~45.8) and Helicobacter pylori infection (OR 7.2; 95% CI; p=0.046 1.0~50.2) were significant risk factors for rebleeding.

Conclusions Despite of successful endoscopic hemostasis for UGIB, the rebleeding rate was considerable. Therefore, physicians need to be cautious about rebleeding if patients have a duodenal lesion, comorbidities or Helicobacter pylori infection