INCIDENCE RATES AND RISK FACTORS FOR GASTROINTESTINAL BLEEDING AFTER ACUTE ISCHEMIC STROKE

Abstract

Background and Aims: Incidence of major gastrointestinal bleeding (GIB) required blood transfusion after acute ischemic stroke (AIS) was reported as 0.5% during hospitalization. However, it is not known about the long-term incidence rates by period after AIS.

Methods: AIS patients who were admitted to the 14 hospitals between 2011 and 2013 were identified using a nationwide multicenter prospective stroke registry database. GIB was captured with diagnosis codes through linkage between registry and claims data. GIB requiring at least 2 packs of blood transfusion was defined as major GIB. Incidence rates were calculated for each epoch; 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3years, after 3 years.

Results: Of 10,818 AIS patients (male, 59%; age, 68±13 years), 947 patients (8.8%) had 1,224 episodes of major GIB during median follow-up of 3.1 years. Twenty percent of these 947 had ⩾2 bleeding episodes. The second bleeding occurred mostly within a month of the first. The incidence rates were highest in the first month with 19.21 per 100 person-years, and gradually decreased to about 1/6 at the first year, and then showed plateau above 3 years. In the multivariable recurrent event analysis, anemia at admission, lower eGFR below 60, and 3-month mRS ⩾4 were independently associated with higher risk of major GIB during the observation periods.

Conclusions: Major GI bleeding occur frequently after AIS in the first month, and the risk was gradually decreased. The efforts are needed to prevent it, especially in patients with anemia and decreased renal function.