Sanguinamenti GI associati a rischio di tromboembolismo

Acute Severe Gastrointestinal Tract Bleeding is Associated with an Increased Risk of Thromboembolism and Death.Nagata N, Sakurai T, Shimbo T, Moriyasu S, Okubo H, Watanabe K, Yokoi C, Yanase M, Akiyama J, Uemura N. Clin Gastroenterol Hepatol. 2017 Jun 17. pii: S1542-3565(17)30735-8

BACKGROUND & AIMS:We performed a retrospective cohort study of patients with and without gastrointestinal bleeding (GIB) to determine whether GIB increases the risks of thromboembolism and death.

METHODS:We collected data from 522 patients with acute severe GIB and 1044 patients without GIB (controls, matched for age, sex, year of diagnosis, history of thromboembolism, and use of antithrombotic drugs) who underwent endoscopy at the National Center for Global Health and Medicine in Japan from January 2009 through December 2014. Hazard ratios (HRs) of GIB for thromboembolism and mortality risk were estimated, adjusting for confounders. We also compared standardized mortality ratios between the GIB cohort and the age- and sex-matched general population in Japan.RESULTS:During a mean follow up of 23.7 months, thromboembolism was identified in 11.5% of patients with GIB and 2.4% of controls (HR, 5.3; 95% CI, 3.3-8.5; P<.001). Multivariate analysis revealed GIB as a risk factor for all-thromboembolic events, cerebrovascular events, and cardiovascular events. During a mean follow up of 24.6 months, 15.9% of patients with GIB and 8.6% of controls died (HR, 2.1; 95% CI, 1.6-2.9; P<.001). Multivariate analysis revealed GIB as a risk factor for all-cause mortality. Compared with the general population, patients with GIB were at increased risk of death (standardized mortality ratio, 12.0).CONCLUSION:In a retrospective analysis of patients undergoing endoscopy in Japan, we identified acute GIB was a significant risk factor for late thromboembolism and death, compared to patients without GIB. GIB also increased risk of death compared with the general population.

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