Role of Antithrombotic Therapy and Nonsteroidal Anti-inflammatory Drug Use in Bleeding Gastroduodenal Ulcers

• Published in: Internal Medicine Vol. 48; no. 9; pp. 631 - 637
• Main Authors: Kishino, Maiko, Nakamura, Shinichi, Shiratori, Keiko, Konishi, Hiroyuki, Shimizu, Shohei
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2009
• Subjects: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; antithrombotic therapy; Female; Fibrinolytic Agents - adverse effects; gastrointestinal bleeding; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - pathology; Gastrointestinal Hemorrhage - prevention & control; Humans; low-dose aspirin; Male; Middle Aged; nonsteroidal anti-inflammatory drugs (NSAIDs); Peptic Ulcer - chemically induced; Peptic Ulcer - pathology; Peptic Ulcer - prevention & control; Retrospective Studies; warfarin
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.48.1793

Objective The aim of this study was to analyze the effects of anti-thrombotic therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) on gastroduodenal bleeding. Patients and Methods The study subjects were 544 patients (421 males and 123 females, mean age, 64.2 years) who were treated endoscopically for bleeding gastroduodenal ulcers from January 1995 to August 2008. Of the 544 patients, 276 (50.7%) had a history of treatment for ≥1 month with an antithrombotic agent or NSAIDs, including low-dose aspirin (n=94), other NSAIDs (n=91), warfarin (n=43), or any combination of the three (combination treatment group; n=48). On the other hand, 268 patients had not previously received any of these drugs (control group). Clinical features and endoscopic therapeutic results were assessed and compared. Results Helicobacter pylori infection was detected in 187 of the 241 (77.6%) patients examined. Of the 544 patients, 199 (36.6%) attended the Department of Cardiology or Cardiovascular Surgery, and 170 (31.3%) patients were already being treated with antiulcer medication, including proton pump inhibitors (n=18 [3.3%]). Forty (7.4%) patients suffered from rebleeding after intervention; the incidence of ulcer rebleeding was not significantly different between patients being treated with any such drugs (4.7% [13/276]) and those that had not previously received any antithrombotic agent or NSAIDs (10.1% [27/268]). Conclusion Antithrombotic therapy and NSAIDs use contributed to bleeding in 50.7% of patients with gastroduodenal ulcers. These drugs are a major cause of ulcer bleeding, but are not necessarily considered a risk factor for rebleeding after endoscopic hemostasis.