Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 723-729
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.723
Long-term prognosis in patients continuing taking antithrombotics after peptic ulcer bleeding
Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Zhen-Yu Zhou, Wei-Jun Jiang
Xi-Xu Wang, Bo Dong, Biao Hong, Yi-Qun Gong, Wei Wang, Jue Wang, Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai 200336, China
Zhen-Yu Zhou, Wei-Jun Jiang, Department of Gastroenterology, Shanghai Tongren Hospital, Shanghai 200336, China
Author contributions: Wang XX, Dong B and Hong B performed the majority of experiments; Hong B, Gong YQ, Wang W, Wang J, Zhou ZY and Jiang WJ provided vital reagents and analytical tools and were also involved in editing the manuscript; Dong B, Hong B, Gong YQ, Wang W and Wang J coordinated the collection of all the human materials in addition to providing financial support for this work; Wang XX, Dong B and Hong B designed the study and wrote the manuscript; Wang XX and Dong B contributed equally to this study.
Supported by Shanghai Health and Family Planning Commission Foundation, No. 201440430.
Institutional review board statement: This study was approved by the Shanghai Tongren Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Biao Hong, Bachlor, Deputy Chief Physician, Department of Vascular Surgery, Shanghai Tongren Hospital, 1111 Xianxia Road, Shanghai 200336, China. gracehong0825@126.com
Telephone: +86-21-52039999 Fax: +86-21-52039999
Received: September 20, 2016
Peer-review started: September 21, 2016
First decision: October 20, 2016
Revised: November 13, 2016
Accepted: December 2, 2016
Article in press: December 2, 2016
Published online: January 28, 2017
Processing time: 120 Days and 19 Hours
Abstract
AIM

To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis.

METHODS

All clinical data of peptic ulcer patients treated from January 1, 2009 to January 1, 2014 were retrospectively collected and analyzed. Patients were divided into either a continuing group to continue taking antithrombotic drugs after ulcer bleeding or a discontinuing group to discontinue antithrombotic drugs. The primary outcome of follow-up in peptic ulcer bleeding patients was recurrent bleeding, and secondary outcome was death or acute cardiovascular disease occurrence. The final date of follow-up was December 31, 2014. Basic demographic data, complications, and disease classifications were analyzed and compared by t- or χ2-test. The number of patients that achieved various outcomes was counted and analyzed statistically. A survival curve was drawn using the Kaplan-Meier method, and the difference was compared using the log-rank test. COX regression multivariate analysis was applied to analyze risk factors for the prognosis of peptic ulcer patients.

RESULTS

A total of 167 patients were enrolled into this study. As for the baseline information, differences in age, smoking, alcohol abuse, and acute cardiovascular diseases were statistically significant between the continuing and discontinuing groups (70.8 ± 11.4 vs 62.4 ± 12.0, P < 0.001; 8 (8.2%) vs 15 (21.7%), P < 0.05; 65 (66.3%) vs 13 (18.8%), P < 0.001). At the end of the study, 18 patients had recurrent bleeding and three patients died or had acute cardiovascular disease in the continuing group, while four patients had recurrent bleeding and 15 patients died or had acute cardiovascular disease in the discontinuing group. The differences in these results were statistically significant (P = 0.022, P = 0.000). The Kaplan-Meier survival curve indicated that the incidence of recurrent bleeding was higher in patients in the continuing group, and the risk of death and developing acute cardiovascular disease was higher in patients in the discontinuing group (log-rank test, P = 0.000 for both). Furthermore, COX regression multivariate analysis revealed that the hazard ratio (HR) for recurrent bleeding was 2.986 (95%CI: 067-8.356, P = 0.015) in the continuing group, while HR for death or acute cardiovascular disease was 5.216 (95%CI: 1.035-26.278, P = 0.028).

CONCLUSION

After the occurrence of peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding.

Keywords: Peptic ulcer bleeding; Antithrombotics; Cardiovascular disease; Risk factor; Survival curve

Core tip: Patients with peptic ulcer bleeding were enrolled into our study, and clinical information was analyzed by statistical method. We found that continuing antithrombotic drugs for peptic ulcer patients increased the risk of recurrent bleeding events, and discontinuing antithrombotic drugs increased the risk of death or cardiovascular events. Our results indicate that clinicians should balance the usage of antithrombotics to reduce the risk of peptic ulcer bleeding.