Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

Abstract

GOALS:

To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding.

BACKGROUND:

Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding.

STUDY:

We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke.

RESULTS:

Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups.

CONCLUSIONS:

Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

• Authors: Seung Young Kim, Jong Jin Hyun, Sang Jun Suh, Sung Woo Jung, Young Kul Jung, Ja Seol Koo, Hyung Joon Yim, Jong Jae Park, Hoon Jai Chun, Sang Woo Lee
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 50 Issue 4 Pg. e40-4 (Apr 2016) ISSN: 1539-2031 [Electronic] United States
• PMID: 26084008 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents

Topics

• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Disease-Free Survival
• Drug Administration Schedule
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage (chemically induced, diagnosis, mortality)
• Proportional Hazards Models
• Risk Assessment
• Risk Factors
• Thrombosis (diagnosis, etiology, mortality, prevention & control)
• Time Factors
• Treatment Outcome