RESUMO
BACKGROUND/AIM: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. PATIENTS AND METHODS: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case-control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed. RESULT: Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow-Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization. CONCLUSION: In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.
Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Hemorragia Gastrointestinal/terapia , Úlcera Péptica/epidemiologia , Inibidores da Agregação Plaquetária/efeitos adversos , Varfarina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Estudos de Casos e Controles , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Varfarina/uso terapêuticoRESUMO
BACKGROUND AND AIM: Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. METHODS: During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. RESULTS: A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. CONCLUSION: In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB.
Assuntos
Hemorragia Gastrointestinal , Trato Gastrointestinal/irrigação sanguínea , Medição de Risco/métodos , Varizes , Idoso , Feminino , Previsões , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Recidiva , Resultado do Tratamento , Varizes/mortalidade , Varizes/terapiaRESUMO
BACKGROUND: Aspirin is a widely used medication for primary and secondary prevention of cardiovascular and cerebrovascular events. The gastrointestinal risks of aspirin are well known, but the frequency of gastroduodenal mucosal injuries in aspirin users in Thailand is currently unknown. OBJECTIVE: The present study was performed to investigate the prevalence of gastroduodenal mucosal injuries in asymptomatic aspirin users. MATERIAL AND METHOD: Asymptomatic patients taking low doses ofaspirin without gastroprotective medication were enrolled and underwent esophagogastroduodenoscopy RESULTS: One hundred four patients were endoscoped. The prevalence of gastroduodenal mucosal injuries (erosions or ulcer) was 63.5%. CONCLUSION: The prevalence of gastroduodenal mucosal injuries was very high in asymptomatic aspirin users.
