IATROGENY AS A COFACTOR IN ACUTE LOWER GASTROINTESTINAL BLEEDING  A PROSPECTIVE STUDY IN PORTUGAL REGIONAL HOSPITALS

C. Cardoso , M. I. Cremers , B. Arroja , R. Ramos , J. Pedrosa , L. Glória , I. Rosa , L. Eliseu , E. Cancela, A. C. Rego, F. Açucena, C. Fonseca   Núcleo de Gastrenterologia dos Hospitais Distritais

OBJECTIVES
 To determine the impact of the use of nonsteroidal anti‐inflamatory, antiplatelet and anticoagulant agents in the severity and prognosis of acute lower gastrointestinal bleeding.

 197 patients (54.2%) were under at least one type of drug
(37.1% antiplatelet, 15.4% nonsteroidal anti‐inflamatory, 6.2% oral anticoagulant, 2.4% low molecular weight heparin and 1.1% unfractionated heparin). The main indications and the duration of therapy are listed bellow.

AIMS & METHODS
 A prospective multicenter study on acute lower gastrointestinal bleeding in 13 Portugal Regional Hospitals for a year (May 2008 to April 2009).

RESULTS
Figure 4

 364 patients (51.6% male; mean age: 72 years ± 14,4) were included. In figure 2 are listed the average values of blood pressure, heart rate, hematocrit, serum creatinine and urea levels at the onset of bleeding.
Blood pressure (mmHg) Heart rate ((bpm) Hematocrit (%) Serum creatinine level (mg/dL) Serum urea level (mg/dL) 119, 5 ±23,8 83,6 ± 16,4

Figure 5- Antiplatelet treatment indications
34,1 ± 7,9 3,5 ±9,9 47,6 ±37,7

Figure 6- Oral anticoagulant treatment indications

Figure 1

Years

Figure 2

 The cause of bleeding was identified in 93,2% patients. The main endoscopic diagnoses were diverticulosis of the colon (39,3%), ischemic colitis(24,4%), colonic polyps (18,4%) and  In this medicated subgroup of patients blood pressure and hematocrit levels were lower (67.6 vs. 70.7 mmHg, p = 0.044
Colon diverticulosis 39,3% 18,4% Ischemic colitis Colonic polyps Colorectal cancer 24,4%

Figure 7‐ Duration of therapy

colorectal cancer (14%).
14,0%

and 32.8 vs 34.5%, p = 0.046) and in patients receiving heparin, the relative risk of rebleeding and mortality was 8 (p = 0.042) and 32 (p = 0.003) times higher in a multivariate analysis.

Figure 3

CONCLUSION
More than half of the patients enrolled were taking at least one type of agent. In this subgroup there was a greater severity of bleeding which, in the case of heparin, was associated with higher rebleeding and mortality rates.