Protective effects of long term antiplatelet and anticoagulant therapy in hospitalized patients with inflammatory bowel disease

Table 1 Patient and hospital characteristics (n = 374744), n (%)

Variable	No drug therapy	Antiplatelet therapy	Anticoagulant therapy	Antiplatelet and anticoagulant therapy	P value
Female	53.9	52.06	52.73	43.28	< 0.001
Male	46.1	47.94	47.27	56.72	< 0.001
Mean age in years	44.02	65.55	58.8	67.97	< 0.001
Insurance provider					< 0.001
Medicare	23.61	63.1	53.73	72.47
Medicaid	20.27	7.6	13.19	8.67
Private	50.01	27.9	30.94	17.09
Uninsured	6.11	1.41	02.14	0.77
Charlson comorbidity index					< 0.001
0	69.24	29.97	41.47	17.16
1	18.68	26.87	22.51	24.13
2	6.36	18.62	15.82	20.9
3 or more	5.72	24.54	20.19	37.81
Median income in patients zip code					< 0.0178
$1-51999	25.8	25.15	23.8	22.65
$52000-65999	25.1	27.3	25.85	30.79
$66000-87999	25.73	25.18	26.59	23.92
$88000+	23.38	22.37	23.76	22.65
Hospital region					< 0.001
Northwest	21.42	19.89	22.13	19.65
Midwest	23.93	27.93	28.43	29.35
South	38.18	36.47	32.84	37.56
West	16.46	15.7	16.6	13.43
Hospital teaching status					0.0001
Non-teaching	26.15	29.81	26.27	25.37
Teaching	73.85	70.19	73.73	74.63
Hospital bed size					0.0224
Small	19.27	21.22	19.3	22.39
Medium	27.89	27.24	28.67	31.59
Large	52.84	51.54	52.03	46.02
Race					< 0.001
White	72.46	82.39	79.82	84.62
Black	14.39	9.66	11.89	10.77
Hispanic	08.42	4.33	5.23	2.82
Asian or Pacific Islander	1.5	1.12	0.96	1.03
Native American	0.39	0.52	0.2	0.26
Other	2.85	1.99	1.91	0.51
Hospital location					< 0.001
Rural	6.7	8.91	6.73	9.7
Urban	93.3	91.09	93.27	90.3

Table 2 Outcomes of hospitalization stratified into four groups based on use of antiplatelet/anticoagulant agents (n = 374744), n (%)

Outcomes	No drug therapy	Antiplatelet therapy	Anticoagulant therapy	Antiplatelet and anticoagulant therapy	P value
Mortality	0.27	0.42	0.62	0.75	0.0016
LOS (days)	4.91	5.01	5.87	5.61	< 0.001
TPN	2.23	1.59	3.33	2.74	0.0001
AKI	7.33	16.13	15.2	21.14	< 0.001
Sepsis	2.0	1.27	1.47	1.24	0.0025
Shock	0.7	1.22	1.55	4.48	< 0.001
Colonoscopy	23.37	27.8	25.96	33.33	< 0.001
Lower GI bleed	3.04	3.95	5.34	6.72	< 0.001
Non variceal Upper GI bleed	0.81	0.95	1.04	1.49	0.1905
Abdominal surgery	10.05	7.53	9.13	5.47	< 0.001
Total charge ($)	46800	45978	54912	50569	< 0.001
Home or home health care	92.84	88.17	86.69	82.84	< 0.001
Short term hospital	1.55	1.03	1.70	1.53	< 0.001
SNF or other facility	2.98	9.52	9.48	13.93	< 0.001

LOS: Length of stay; TPN: Total parenteral nutrition; AKI: Acute kidney injury; GI: Gastrointestinal; SNF: Skilled nursing facility.

Table 3 Results of multivariate regression analysis after adjusting for confounders

Outcome	Unadjusted OR/coefficient (95%CI)	P value	Adjusted OR/coefficient (95%CI)	P value
Mortality (OR)
Antiplatelet	1.55 (0.93-2.60)	0.09	0.40 (0.23-0.70)	0.001
Anticoagulant	2.27 (1.36-3.80)	0.002	0.41 (0.22-0.75)	0.004
Antiplatelet and anticoagulant	2.74 (0.87-8.67)	0.085	0.23 (0.05-1.01)	0.052
LOS days (coefficient)
Antiplatelet	0.096 (-0.06-0.25)	0.249	-0.46 (-0.63 to -0.28)	< 0.001
Anticoagulant	0.96 (0.71-1.20)	0.000	-0.502 (-0.78 to -0.22)	< 0.001
Antiplatelet and anticoagulant	0.698 (0.06-1.32)	0.030	-0.95 (-1.62 to -0.27)	< 0.001
AKI (OR)
Antiplatelet	2.43 (2.21-2.66)	< 0.001	0.95 (0.85-1.05)	0.354
Anticoagulant	2.26 (2.02-2.53)	< 0.001	0.99 (0.86-1.14)	0.942
Antiplatelet and anticoagulant	3.38 (2.66-4.31)	< 0.001	0.92 (0.69-1.22)	0.586
Sepsis (OR)
Antiplatelet	0.63 (0.47-0.84)	0.002	0.78 (0.57-1.06)	0.117
Anticoagulant	0.73 (0.52-1.00)	0.057	0.77 (0.54-1.10)	0.154
Antiplatelet and anticoagulant	0.62 (0.25-1.48)	0.279	0.78 (0.32-1.94)	0.586
Shock (OR)
Antiplatelet	1.76 (1.29-2.39)	< 0.001	0.75 (0.53-1.05)	0.103
Anticoagulant	2.24 (1.62-3.09)	< 0.001	0.64 (0.43-0.94)	0.025
Antiplatelet and anticoagulant	6.68 (4.14-10.76)	< 0.001	1.52 (0.88-2.63)	0.129
TPN (OR)
Antiplatelet	0.7 (0.54-0.92)	0.01	0.76 (0.57-1.01)	0.064
Anticoagulant	1.5 (1.21-1.87)	< 0.001	1.07 (0.83-1.40)	0.569
Antiplatelet and anticoagulant	1.23 (0.64-2.33)	0.522	1.05 (0.53-2.077)	0.877
Lower GI bleed (OR)
Antiplatelet	1.31 (1.10-1.55)	0.002	1.05 (0.87-1.26)	0.578
Anticoagulant	1.79 (1.50-2.14)	< 0.001	1.34 (1.09-1.65)	0.004
Antiplatelet and anticoagulant	2.29 (1.58-3.40)	< 0.001	1.56 (1.03-2.37)	0.035
Non-variceal upper GI bleed (OR)
Antiplatelet	1.18 (0.84-1.66)	0.325	1.13 (0.78-1.65)	0.505
Anticoagulant	1.29 (0.87-1.91)	0.189	1.03 (0.64-1.64)	0.891
Antiplatelet and anticoagulant	1.86 (0.82-4.18)	0.132	1.47 (0.62-3.46)	0.376
Colonoscopy (OR)
Antiplatelet	1.26 (1.17-1.36)	< 0.001	1.16 (1.07-1.26)	< 0.001
Anticoagulant	1.14 (1.04-1.26)	0.003	0.99 (0.90-1.26)	0.95
Antiplatelet and anticoagulant	1.63 (1.32-2.03)	< 0.001	1.31 (1.04-1.66)	0.019
Abdominal surgery (OR)
Antiplatelet	0.73 (0.64-0.82)	< 0.001	0.836 (0.72-0.96)	0.014
Anticoagulant	0.89 (0.78-1.02)	0.123	0.879 (0.74-1.03)	0.118
Both antiplatelet and anticoagulant	0.51 (0.33-0.79)	0.03	0.623 (0.39-0.97)	0.037
Total charge ($) (coefficient)
Antiplatelet	-822.2 (-2777-1132)	0.41	-4889 (-7126 to -2652)	< 0.001
Anticoagulant	8112 (5015-11208)	< 0.001	-7094 (-10979 to -3209)	< 0.001
Antiplatelet and anticoagulant	3768 (-3105-10643)	0.283	-11546 (-19475 to -3617)	< 0.001
Discharge to home or home health care (OR)
Antiplatelet	0.57 (0.51-0.63)	< 0.0001	1.23 (1.10-1.37)	< 0.001
Anticoagulant	0.50 (0.44-0.56)	< 0.0001	1.32 (1.14-1.15)	< 0.001
Antiplatelet and anticoagulant	0.37 (0.28-0.48)	< 0.0001	1.47 (1.07-2.01)	0.015
Discharge to short term hospital (OR)
Antiplatelet	0.66 (0.47-0.92)	0.015	0.56 (0.39-0.81)	0.02
Anticoagulant	1.10 (0.81-1.49)	0.535	0.84 (0.59-1.12)	0.362
Antiplatelet and anticoagulant	1.12 (0.53-2.38)	0.756	0.76 (0.33-1.74)	0.521
Discharge to SNF or other facility (OR)
Antiplatelet	3.42 (0.05-3.08)	< 0.001	0.94 (0.83-1.07)	0.403
Anticoagulant	3.40 (2.96-3.92)	< 0.001	0.80 (0.66-0.95)	0.016
Antiplatelet and anticoagulant	5.26 (3.93-7.05)	< 0.001	0.78 (0.55-1.10)	0.169

OR: Odds ratio; LOS: Length of stay; TPN: Total parenteral nutrition; AKI: Acute kidney injury; GI: Gastrointestinal; SNF: Skilled nursing facility.