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Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding

Authors
Kim, Seung YoungHyun, Jong JinSuh, Sang JunJung, Sung WooJung, Young KulKoo, Ja SeolYim, Hyung JoonPark, Jong JaeChun, Hoon JaiLee, Sang Woo
Issue Date
Apr-2016
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
bleeding ulcer; antithrombotics; cardiovascular events
Citation
JOURNAL OF CLINICAL GASTROENTEROLOGY, v.50, no.4, pp.E40 - E44
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF CLINICAL GASTROENTEROLOGY
Volume
50
Number
4
Start Page
E40
End Page
E44
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/6593
DOI
10.1097/MCG.0000000000000354
ISSN
0192-0790
Abstract
Goals:To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding.Background:Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding.Study:We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke.Results:Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups.Conclusions:Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.
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Chun, Hoon Jai
Anam Hospital (Department of Gastroenterology and Hepatology, Anam Hospital)
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