Older age predicts early mortality after upper GI bleeding

Older age was the strongest predictor of early mortality in adults with gastrointestinal bleeding, after investigators controlled for medications and comorbidities, according to data from more than 1,000 adults treated at a single medical center.

In recent years, more clinicians have prescribed low-dose aspirin and antithrombotic agents for cardiovascular disease prevention, but the interaction of these products with other risk factors for GI bleeding has not been studied thoroughly.

“To assess the 30-day mortality after upper gastrointestinal bleeding in association with the use of NSAIDs low-dose aspirin, and other antithrombotic drugs,” of Cross House Hospital and the university of Glasgow, Scotland, presented at the annual Digestive Disease Week.

The investigators analyzed data from 1,014 adults who presented with a first episode of upper GI bleeding. A total of 45% of the patients were aged 65 years and older, and 8.1% of these patients died within 30 days of bleeding, compared with 1.3% of the younger patients.

After adjustment for multiple variables, patients aged 65 years and older had a significantly greater risk of 30-day mortality, compared with their younger counterparts. In a univariate analysis, cerebrovascular disease, cardiovascular disease, and use of diuretics, dioxin, and either low-dose aspirin or other antithrombotic drugs were significantly associated with an increased risk of 30-day mortality.

Low-dose aspirin was defined as 75 mg/day, and the antithrombotic drugs included clopidogrel, Dipyridamole, and warfarin.

Use of NSAIDs had no significant impact on 30-day mortality. The Blatchford score (an accepted measure of risk in patients with upper GI bleeding) was calculated using both clinical and laboratory data at each patient’s presentation. Patients scoring higher than 10 on this measure had five times the risk of early death, compared with patients scoring 0-2.

Despite the importance of comorbidities and medication use, the results suggest the age is a strong and independent predictor of early mortality in patients with upper GI bleeding. More studies are needed to determine the clinical implications for treatment.

“Ulcer prevention should be considered seriously in elderly patients, particularly in the presence of other comorbid conditions and use of ulcerogenic drugs. “And once bleeding has taken place, such patients should be targeted for intensive management.”