Antitrombotik tedavi altında üst gastrointestinal kanamada morbidite ve mortalitenin değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, antitrombotik ilaç kullanan ve kullanmayan akut üst gastrointestinal (Gİ) kanamalı hastaları karşılaştırarak, bu ilaçların klinik seyir, endoskopik bulgular, laboratuvar değerleri, hastanede yatış süresi ve hastane içi mortalite üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntemler: Ocak 2023 ile Mart 2025 tarihleri arasında Ankara Bilkent Şehir Hastanesi Gastroenteroloji Kliniği'nde üst Gİ kanama tanısı alan toplam 405 hasta retrospektif olarak incelendi. Hastalar antitrombotik ilaç kullanımına göre dört gruba ayrıldı: ilaç kullanmayanlar, yalnızca antiplatelet kullananlar, yalnızca antikoagülan kullananlar ve her iki ilacı birlikte kullananlar. Klinik, laboratuvar ve endoskopik veriler analiz edildi. Antitrombotik ilaç kullanımı ile mortalite arasındaki ilişki çok değişkenli lojistik regresyon modelleri ve eğilim skoru eşleştirme (PSM) yöntemi ile değerlendirildi. Bulgular: Antitrombotik ilaç kullanan hastalar anlamlı derecede daha yaşlıydı (74,3 ± 12,1 vs. 53,5 ± 19,3 yıl, p<0,001) ve daha fazla komorbiditeye sahipti. Bu grupta hemoglobin düzeyleri daha düşük, üre, kreatinin ve INR değerleri ise daha yüksekti (tüm p<0,001). Endoskopik bulgular iki grup arasında anlamlı fark göstermedi. Hastane içi mortalite, antitrombotik kullananlarda daha yüksek olmasına rağmen (yüzde 6,6 vs. yüzde 2,9), bu fark istatistiksel olarak anlamlı değildi (p=0,126). PSM ve çok değişkenli analiz sonrasında antitrombotik ilaç kullanımının mortalite ile bağımsız ilişkisi bulunmadı. Bununla birlikte, bu hastalarda yatış süresi daha uzundu (9,3 vs. 6,1 gün, p<0,001) ve hemoglobinde daha fazla düşüş gözlendi (p=0,027). Sonuç: Gİ kanama sonrası mortalite, antitrombotik ilaç kullanan hastalarda daha yüksek görünse de, bu fark esas olarak ileri yaş ve komorbidite yüküne bağlıdır. Antitrombotik ilaçların tek başına mortalite üzerinde bağımsız bir etkisi gösterilememiştir. Bununla birlikte, bu hasta grubunda artan morbidite göz ardı edilmemelidir. Klinik kararlar, hastanın genel durumu göz önünde bulundurularak bireyselleştirilmelidir.

Anahtar Kelimeler

• antitrombotik tedavi
• üst gastrointestinal kanama
• mortalite
• morbidite
• endoskopik bulgular

Evaluation of morbidity and mortality in upper gastrointestinal bleeding under antithrombotic therapy

Öz

Aim: The aim of this study is to evaluate the effects of antithrombotic drugs on clinical course, endoscopic findings, laboratory values, hospital stay duration, and in-hospital mortality by comparing acute upper gastrointestinal (GI) bleeding patients who use and do not use these drugs. Materials and Methods: A total of 405 patients diagnosed with upper GI bleeding at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2023 and March 2025 were retrospectively reviewed. Patients were divided into four groups based on antithrombotic drug use: those not using drugs, those using only antiplatelet drugs, those using only anticoagulants, and those using both drugs together. Clinical, laboratory, and endoscopic data were analyzed. The association between antithrombotic drug use and mortality was evaluated using multivariate logistic regression models and propensity score matching (PSM). Results: Patients using antithrombotic drugs were significantly older (74.3 ± 12.1 vs. 53.5 ± 19.3 years, p<0.001) and had more comorbidities. Hemoglobin levels were lower, and urea, creatinine, and INR values were higher in this group (all p<0.001). Endoscopic findings did not show significant differences between the two groups. Although in-hospital mortality was higher among antithrombotic users (6.6% vs 2.9%), this difference was not statistically significant (p=0.126). After PSM and multivariate analysis, the independent association of antithrombotic drug use with mortality was no longer present. However, these patients had a longer length of stay (9.3 vs. 6.1 days, p<0.001) and a greater decrease in hemoglobin (p=0.027). Conclusion: Although the mortality rate after GI bleeding appears to be higher in patients using antithrombotic drugs, this difference is mainly due to advanced age and comorbidity burden. Antithrombotic drugs alone have not been shown to have an independent effect on mortality. However, increased morbidity in this patient group should not be overlooked. Clinical decisions should be individualized, taking into account the patient's overall condition.

Anahtar Kelimeler

• antithrombotic therapy
• upper gastrointestinal bleeding
• mortality
• morbidity
• endoscopic findings

Kaynakça

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