Cardiovascular Outcomes following Major Gastrointestinal Bleeding in Patients with Pre-existing Cardiovascular Disease: the INTERBLEED International Prospective Cohort Study.
Gastrointestinal bleeding (GIB) is common in patients with cardiovascular (CV) disease, but a complete understanding of subsequent outcomes is unknown. We assessed outcomes following GIB in patients with CV disease.
INTERBLEED is an international multi-center prospective study comparing adults with CV disease (coronary or peripheral arterial disease, heart failure, atrial fibrillation, cerebrovascular disease, or venous thromboembolic disease) with GIB to those without. Outcomes included major adverse cardiovascular events (MACE - myocardial infarction, stroke, or CV-related death), all-cause death, and recurrent GIB at 12 months. Multivariable regression modelling yielded odds ratios (ORs) with 95% confidence intervals (CIs), and reverse Kaplan Meier curves were created.
A total of 3,814 patients were enrolled: 1,612 patients with GIB and 2,202 without. On multivariable analyses, patients with CV disease experiencing GIB were more likely to die within 12 months (OR 2.29, 95%CI 1.24-4.19). GIB was associated with recurrent GIB (OR 4.28, 95%CI 2.80-6.53) but not MACE. However, resumption of antithrombotic therapy between 4-7 days (OR 0.37, 95%CI 0.17-0.83) or 8-30 days (OR 0.37, 95%CI 0.17-0.81) following GIB were associated with lower odds of MACE within 12 months compared to discontinuation or lack of resumption within 60 days. Any antithrombotic use following enrolment was associated with lower all-cause death (OR 0.45, 95%CI 0.28-0.71). Neither antithrombotic use nor early resumption was associated with higher odds of recurrent GIB.
GIB in patients with CV disease is independently associated with subsequent morbidity and mortality. Patterns in antithrombotic resumption were associated with outcomes. Further research into optimal antithrombotic management following GIB is essential.
INTERBLEED is an international multi-center prospective study comparing adults with CV disease (coronary or peripheral arterial disease, heart failure, atrial fibrillation, cerebrovascular disease, or venous thromboembolic disease) with GIB to those without. Outcomes included major adverse cardiovascular events (MACE - myocardial infarction, stroke, or CV-related death), all-cause death, and recurrent GIB at 12 months. Multivariable regression modelling yielded odds ratios (ORs) with 95% confidence intervals (CIs), and reverse Kaplan Meier curves were created.
A total of 3,814 patients were enrolled: 1,612 patients with GIB and 2,202 without. On multivariable analyses, patients with CV disease experiencing GIB were more likely to die within 12 months (OR 2.29, 95%CI 1.24-4.19). GIB was associated with recurrent GIB (OR 4.28, 95%CI 2.80-6.53) but not MACE. However, resumption of antithrombotic therapy between 4-7 days (OR 0.37, 95%CI 0.17-0.83) or 8-30 days (OR 0.37, 95%CI 0.17-0.81) following GIB were associated with lower odds of MACE within 12 months compared to discontinuation or lack of resumption within 60 days. Any antithrombotic use following enrolment was associated with lower all-cause death (OR 0.45, 95%CI 0.28-0.71). Neither antithrombotic use nor early resumption was associated with higher odds of recurrent GIB.
GIB in patients with CV disease is independently associated with subsequent morbidity and mortality. Patterns in antithrombotic resumption were associated with outcomes. Further research into optimal antithrombotic management following GIB is essential.
Authors
Forbes Forbes, Eikelboom Eikelboom, Yi Yi, Moayyedi Moayyedi, Alings Alings, Bangdiwala Bangdiwala, Barkun Barkun, Cassella Cassella, Duzen Duzen, Hamilton Hamilton, Kilickap Kilickap, Kruger Kruger, Liang Liang, Nicolau Nicolau, Nunes Nunes, O'Donnell O'Donnell, Rey Rey, Islam Islam, Vanassche Vanassche, Verhamme Verhamme, Wu Wu, Zhao Zhao, Zhu Zhu, Bosch Bosch
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