Clinical Analysis Of Upper Gastrointestinal Hemorrhage Associated With Antiplatelet Aggregation Drugs

Objective:To investigate the clinical characteristics and influencing factors of upper gastrointestinal bleeding associated with antiplatelet aggregation drugs.Methods: A retrospective review of 172 cases of non-varicose upper gastrointestinal bleeding(NVUGIB)associated with antiplatelet drugs admitted to the union hospital affiliated to our university from January 2014 to October 2018,as the anti-platelet group(group B).A total of 174 inpatients with NVUGIB not using antiplatelet drugs were selected as non-antiplatelet group(group A)by random number table method.The group B was divided into 92 cases as single antiplatelet group(group B1,taking aspirin or clopidogrel)and 80 cases as dual antiplatelet group(group B2,taking aspirin+ clopidogrel or aspirin+ticagrelor).Compare the differences of age,sex,body mass index(BMI),past history,clinical feature,examination results,combined use proton pump inhibitor(PPI),bleeding causes,severity of bleeding,and prognosis among each group,then analyze the risk factors of severe upper gastrointestinal.Results:(1)Comparison of basic data between group A and group B:compared with group A,group B was older(73.29±10.47 Y vs.61.37±18.07 Y,P<0.001),more BMI ? 25kg/m 2(P < 0.001),more patients with coronary heart disease,PCI,hypertension,diabetes,cerebral infarction,less patients with peptic ulcer history(P<0.05).(2)Comparison of clinical features,examination results,bleeding severity and prognosis between group A and group B:compared with group A,group B showed fewer digestive symptoms(P=0.008),more circulatory failure(P=0.042),more fecal occult blood positive(P=0.003),longer hospital stay(P < 0.001),lower hemoglobin concentration(P=0.027),higher incidence of high-risk ulcer(P=0.016),higher proportion of deterioration(including death)(P=0.005),and lower rate of HP screening(P<0.001).The proportion of duodenal ulcer in group A was higher than that in group B(P=0.013).(3)Comparison of basic data,clinical features and prognosis between group B1 and group B2:the average age of patients in group B1 was older than that in group B2(74.82±9.92 Y vs.71.54±10.88 Y,P=0.040).In group B2,the proportion of combined use PPI was higher(P=0.009).There was no significant differences between the two groups in the history of hypertension,diabetes,peptic ulcer bleeding,digestive symptoms,circulatory failure,primary haemorrhagic presentation,gender,duration of antiplatelet therapy,severity and outcome.(4)Logistic univariate and multivariate analysis of severe upper gastrointestinal bleeding in group B: the univariate analysis suggested that age,history of peptic ulcer bleeding and creatinine were the risk factors of severe upper gastrointestinal bleeding associated with antiplatelet drugs.Further Logistic multivariate analysis suggested that history of peptic ulcer bleeding(OR:4.654,95%CI:1.791-12.098,P=0.002)and creatinine(OR:2.587,95%CI:1.014-6.597,P=0.047)were independent risk factors.Conclusion:The patients of upper gastrointestinal bleeding associated with antiplatelet drugs is elder,and more history of coronary heart disease,PCI,hypertension,diabetes and cerebral infarction.These patients had fewer digestive symptoms,more circulatory failure,lower hemoglobin concentration,longer longer hospital stay,higher incidence of high-risk ulcer and more deterioration.The history of peptic ulcer bleeding and creatinine were independent risk factors for severe upper gastrointestinal bleeding associated with antiplatelet drugs.The proportion of combined use PPI in the antiplatelet group was relatively low,indicating that there was still insufficient attention paid to the prevention of upper gastrointestinal bleeding caused by antiplatelet drugs clinically.