Lower gastrointestinal bleeding in patients with coronary artery disease on antithrombotics and subsequent mortality risk
© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd..
BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common complication for patients with coronary artery disease (CAD) due to the use of antithrombotic medications. Limited data exist describing which patients are at increased risk for mortality.
AIM: This study aims to (i) determine whether patients on dual antiplatelet therapy (DAPT) or triple therapy are at higher risk of 90-day and 6-month mortality compared with patients on aspirin alone and (ii) 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: Seven hundred sixteen patients were identified with LGIB and CAD. Four hundred seventy-two (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 (hazard ratio [HR] 3.12, 95% confidence interval [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, the 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 at 90 days and at 6 months post discharge.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2018 |
|---|---|
| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
|---|---|
| Enthalten in: |
Journal of gastroenterology and hepatology - 33(2018), 6 vom: 10. Juni, Seite 1185-1191 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Patel, Parita [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anticoagulants |
|---|
| Anmerkungen: |
Date Completed 20.08.2018 Date Revised 20.08.2018 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/jgh.14048 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM278227104 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM278227104 | ||
| 003 | DE-627 | ||
| 005 | 20231225020054.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2018 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/jgh.14048 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0927.xml |
| 035 | |a (DE-627)NLM278227104 | ||
| 035 | |a (NLM)29156506 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Patel, Parita |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Lower gastrointestinal bleeding in patients with coronary artery disease on antithrombotics and subsequent mortality risk |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.08.2018 | ||
| 500 | |a Date Revised 20.08.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. | ||
| 520 | |a BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common complication for patients with coronary artery disease (CAD) due to the use of antithrombotic medications. Limited data exist describing which patients are at increased risk for mortality | ||
| 520 | |a AIM: This study aims to (i) determine whether patients on dual antiplatelet therapy (DAPT) or triple therapy are at higher risk of 90-day and 6-month mortality compared with patients on aspirin alone and (ii) evaluate risk factors for mortality in patients with CAD on antithrombotics hospitalized with LGIB | ||
| 520 | |a 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 | ||
| 520 | |a RESULTS: Seven hundred sixteen patients were identified with LGIB and CAD. Four hundred seventy-two (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 (hazard ratio [HR] 3.12, 95% confidence interval [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, the use of triple therapy remained associated with higher 90-day mortality (HR 3.23, 95%CI 1.56-6.16, P = 0.003) | ||
| 520 | |a CONCLUSION: Triple therapy is associated with mortality at 90 days and at 6 months post discharge | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antithrombotics | |
| 650 | 4 | |a lower gastrointestinal bleeding | |
| 650 | 4 | |a mortality | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 650 | 7 | |a Pyridines |2 NLM | |
| 650 | 7 | |a thienopyridine |2 NLM | |
| 650 | 7 | |a Aspirin |2 NLM | |
| 650 | 7 | |a R16CO5Y76E |2 NLM | |
| 700 | 1 | |a Nigam, Neha |e verfasserin |4 aut | |
| 700 | 1 | |a Sengupta, Neil |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of gastroenterology and hepatology |d 1989 |g 33(2018), 6 vom: 10. Juni, Seite 1185-1191 |w (DE-627)NLM012635235 |x 1440-1746 |7 nnns |
| 773 | 1 | 8 | |g volume:33 |g year:2018 |g number:6 |g day:10 |g month:06 |g pages:1185-1191 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/jgh.14048 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 33 |j 2018 |e 6 |b 10 |c 06 |h 1185-1191 | ||