Anticoagulación luego de una hemorragia por úlcera péptica: riesgos de trombosis, mortalidad y sangrado recurrente

Abstract

Background. Patients on chronic anticoagulation face a higher risk of peptic ulcer bleeding. In this setting, the risk-benefit equation of anticoagulation resumption remains undefined. Aims. To compare the risk of thrombosis and death between patients that resumed and did not resume anticoagulation after an index episode of peptic ulcer bleeding. The secondary objective was to compare time to re-bleeding between the groups. Methods. Retrospective cohort study of adult patients that suffered an index episode of peptic ulcer bleeding while on chronic anticoagulation. Patients were divided into two groups according to whether they resumed or not anticoagulation and were followed-up for one year. A multivariable, propensity score-adjusted Cox proportional hazards model was used to adjust for confounding. Adjusted survival curves were constructed. Results. 70 patients were included in the analysis; 64.3% were men. Median age at the time of PUB was 79 years (interquartile range (IQR): 72-83). Forty patients (57.1%) resumed anticoagulation after a median time of 15 days (IQR 5.25-41.75). Restarting anticoagulation was associated with a lower risk of thrombosis or death (hazard ratio [HR] 0.14; 95%CI 0.05-0.43) and did not increase the risk of recurrent bleeding significantly (HR 1.42; 95% CI 0.10-19.8). Conclusions. Resuming anticoagulation appears to reduce the hazard of thrombosis and death without increasing the risk of recurrent bleeding significantly.