Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding

Table 1 Clinical characteristics of patients with non-variceal upper gastrointestinal bleeding in both groups n (%)

Group	No anti-thrombotics n = 263	Aspirin n = 94	P value
Age mean (SD)	58.4 (19.1)	66.8 (13.1)	< 0.001
Male gender	169 (64.3)	71 (75.5)	0.05
Smoking	60 (27.0)	34 (41.0)	0.02
Diabetes mellitus	31 (11.8)	25 (26.6)	0.001
Hypertension	74 (28.1)	44 (46.8)	0.001
Dyslipidemia	16 (6.1)	21 (22.3)	< 0.0001
Cancer	55 (20.9)	6 (6.4)	0.001
NSAIDS	47 (17.9)	16 (17.0)	0.85
PPI	29 (11.0)	4 (4.3)	0.05
History of peptic ulcer disease	69 (26.2)	13 (13.8)	0.01

P < 0.05 is considered significant. NVUGIB: Non-variceal upper gastrointestinal bleeding; Aspirin: Aspirin only; No anti-thrombotics: Including clopidogrel, coumadin, heparin, ticlopedine and dypiradamole; SD: Standard deviation; NSAIDS: Non steroidal anti-inflammatory drug; PPI: Proton pump inhibitor.

Table 2 Association between aspirin use and presentation/management n (%)

Group	No anti-thrombotics n = 263	Aspirin n = 94	P value
Melena	109 (41.4)	51 (54.3)	0.03
Hematemesis	76 (28.9)	17 (18.1)	0.04
Hematemesis + Melena	46 (17.5)	16 (17.05)	0.92
Hematochezia	8 (3.0)	2 (2.1)	0.48
Syncope	33 (12.5)	20 (21.3)	0.04
Hgb, g/L, mean (SD)	9.2 (2.8)	9.1 (2.4)	0.80
Hct, (%), mean (SD)	27.4 (8.2)	27.0 (7.1)	0.70
INR, mean (SD)	1.2 (0.7)	1.0 (0.2)	0.003
Gastric ulcers	40 (15.2)	27 (28.7)	0.004
Duodenal ulcers	65 (24.7)	31 (33.0)	0.12
Erosive esophagitis	31 (11.8)	10 (10.6)	0.76
Erosive gastritis	34 (12.9)	38 (40.4)	< 0.0001
Erosive duodenitis	14 (5.3)	15 (16.0)	0.001
Mallory Weiss	18 (6.8)	4 (4.3)	0.37
Hiatal Hernia	24 (9.1)	11 (11.7)	0.47
AVM	11 (4.2)	3 (3.2)	0.47
Cancer	6 (2.3)	0 (0.0)	0.16
Transfusion-unit	4.7 (5.5)	4.0 (3.8)	0.25
Mean (SD)
Transfusion %	161 (61.2)	66 (70.2)	0.12
Thermal coagulation	25 (9.5)	14 (14.9)	0.15
Hemostatic clips	2 (0.8)	0 (0.0)	0.54
Argon-plasma coagulation	4 (1.5)	2 (2.1)	0.50
Angiography-embolization	1 (0.4)	0 (0.0)	0.74
Surgery	21 (8.0)	5 (5.3)	0.39

P < 0.05 is considered significant. NVUGIB: Non-variceal upper gastrointestinal bleeding; Aspirin: Aspirin only; No anti-thrombotics: Including clopidogrel, coumadin, heparin, ticlopedine and dypiradamole; SD: Standard deviation; Hgb: Hemoglobin; Hct: Hematocrit; INR: International normalized ratio; AVM: Arteriovenous malformation; Surgery as any type of surgical procedure performed to control gastrointestinal bleeding.

Table 3 Multivariate analyses of the outcomes in aspirin users vs non users

Group	No anti-thrombotics n = 263	Aspirin n = 94	P value	Crude OR (95%CI)	Adjusted OR (95%CI)
Mortality	36 (13.7)	2 (2.1)	0.002	0.14 (0.03-0.58)	0.15 (0.03-0.64)
Hospital stay (d)	7.0 (10.3)	4.9 (3.5)	0.01
Mean (SD)
Complications-Thrombo-embolic	3 (1.1)	3 (3.2)	0.19	2.86 (0.57- 14.41)	4.79 (0.77-29.96)
Complications-infection1	40 (15.2)	14 (14.9)	0.94	0.98 (0.50-1.89)	0.90 (0.45-1.81)
Complications-respiratory2	15 (5.7)	3 (3.2)	0.42	0.55 (0.15-1.93)	0.58 (0.15-2.19)
Complications-myocardial infarction	3 (1.1)	1 (1.1)	1	0.93 (0.10-9.07)	0.68 (0.07-6.79)
Complications-renal failure	30 (11.4)	9 (9.6)	0.63	0.82 (0.38-1.80)	0.68 (0.30-1.55)
Complications-DIC	7 (2.7)	0 (0.0)	0.2
All in hospital complications	79 (30.0)	26 (27.7)	0.66	0.89 (0.53-1.50)	0.76 (0.43-1.32)
Composite outcome3	63 (24.0)	10 (10.6)	0.01	0.38 (0.19-0.77)	0.42 (0.20-0.89)
Severe hemorrhage	97 (36.9)	37 (39.4)	0.67	1.11 (0.69-1.80)	1.18 (0.70-1.99)
Re-bleeding	5 (5.3)	27 (10.3)	0.15	0.49 (0.18-1.32)	0.42 (0.15-1.19)

¹Complications-infection composite: Including pneumonia, aspiration pneumonia, sepsis, urinary tract infection, skin infection;

²Complications-respiratory composite: Including ARDS and mechanical ventilation;

³Composite outcome include mortality, severe bleeding, re-bleeding, need for surgery or embolization. Severe hemorrhage was defined as BP < 90 mmHg, HR > 120 b/min, Hb < 7 g/dL on presentation, or transfusion of > 3 units of blood during hospitalization; rebleeding was defined as recurrence of hematemesis, coffee ground emesis, or melena occurring after 24 h from initial endoscopic evaluation and/or hemostatic therapy and initial stabilization, accompanied by either a decrease in hemoglobin concentration of at least 2 g/L or change in vital signs. P < 0.05 is considered significant. Aspirin: Aspirin only; No anti-thrombotics: Including clopidogrel, coumadin, heparin, ticlopedine and dypiradamole; OR: Odds ratio; DIC: Disseminated intravascular coagulation.