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The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2017;17(1):33-38.
DOI: https://doi.org/10.7704/kjhugr.2017.17.1.33    Published online March 10, 2017.
Severe Upper Gastrointestinal Bleeding in Patients on Antithrombotic Therapy
Ji Hye Kwak, Cha Young Kim, Hong Jun Kim, Chang Yoon Ha, Hyun Jin Kim, Tae Hyo Kim, Ok Jae Lee
1Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea. ojlee@gnu.ac.kr
2Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea.
항혈전제 복용 환자에서 발생한 중대한 상부위장관 출혈
곽지혜1, 김차영1, 김홍준1,2, 하창윤1,2, 김현진1,2, 김태효1,2, 이옥재1,2
경상대학교 의과대학 내과학교실1, 건강과학연구원2
Received: 25 September 2016   • Revised: 27 December 2016   • Accepted: 8 January 2017
As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.
Key Words: Upper gastrointestinal hemorrhage; Antithrombotic therapy; Endoscopy; Hemostasis

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