HEMORRHAGE IN GASTRODUODENAL LESIONS.

Background: Some of the most common challenges in medical world are the management of pain, inflammation, as well as various cardiovascular diseases. This is the reason why anti-inflammatory, antiplatelet and anticoagulant drugs are widely used. Concomitantly with the beneficial effects, these drugs increase the risk of nonvariceal upper gastrointestinal bleeding, as they may cause ulceration of the upper gastrointestinal mucosa directly or may cause more abundant bleeding or rebleeding. Objective: The aim of this paper was to investigate outcomes of acute upper gastrointestinal bleeding and to examine the role of drugs potentially associated with hemorrhagic event. Material and methods: This retrospective study, includes a total of 214 patients admitted to the Gastroenterology Department of the Mureş Clinical Country Hospital, between January 2021 and December 2022,with main manifestations of hematemesis and/or melena and endoscopic diagnosis of gastroduodenal lesion (ulcer, erosion).The batch was divided into 6 groups according to the consumption of drugs. We analyzed clinical parameters, comorbid diseases, the need for blood transfusion and duration of hospitalization. Rockall and Blatchford prognostic scoring systems were used to assess the risk of rebleeding and death. Results : Regarding the history of drug consumption, the patients were assigned to an unexposed group consisting of 115 subjects (54 %)(group 1) and an exposed group represented by 99 patients (46%).Of the 99 patients, 14.5% on anticoagulant, whether it is vitamin K antagonists or direct oral anticoagulants (group 2), 10.3% on aspirin only (group 3), 4.2% on dual antiplatelet therapy (group 4), 5.1% on combined antiplatelet-anticoagulant therapy (group 5) and 19.2% consume non-steroidal/steroidal anti-inflammatory drugs (group 5).A prior history of upper gastrointestinal bleeding prevails in the exposed group (p=0.018).Pharmacotherapy potentially associated with upper gastrointestinal bleeding, especially anticoagulant treatment (p=0.017) proved to be an independent predictor for clinically significant bleeding, defined by the presence of clinical signs of hemorrhagic shock, or the need for transfusion (OR=1.908,p=0.017).Among patients on anticoagulant monotherapy and combined antiplatelet-anticoagulant, the Blatchford score was higher than in the other groups (p=0,029).Also, the Rockall score in group 2 was higher than in the unexposed group (p=0.012).The transfusion requirement was higher in exposed group(p=0,018),especially in group 2 (p=0.037).We noticed a higher length of hospitalization among patients on anticoagulant treatment than the unexposed group (p=0.044). Conclusions: Anticoagulants proved to be an independent predictor for a major bleeding event, increasing the need for blood transfusion, the duration of hospitalization, the risk of rebleeding and death. [ABSTRACT FROM AUTHOR]