P1527 - Bleeding Site and High INR Are Associated With Rebleeding in Patients on Dual Anti-Platelet Therapy Undergoing Endotherapy for Non-Variceal Upper Gastrointestinal Bleed

Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD
Allegheny Health Network, Pittsburgh, PA

Introduction: Early and delayed rebleeding after endotherapy is a major cause of repeat admissions in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). There is a paucity of data on clinical and endoscopic factors associated with rebleeding events. Identification of risk factors for rebleeding may help identify patients at a higher risk of rebleeding.

Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on dual
anti-platelet therapy (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent endoscopy. Patients who had DAPT held as per ASGE guidelines were excluded from the study. Non-normally distributed variables were expressed as medians with IQR range. The Mann-Whitney U test and the Freeman-Halton extension of Fisher’s exact test were used for comparison between the rebleeding and non-rebleeding groups. P-value < 0.05 was considered as the level of
significance.

Results: Out of 203 patients, 75 were included for final analysis. 17/75 (22.7%) patients experienced rebleeding. Clinical and endoscopic characteristics were compared between patients with and without rebleeding. Patients with rebleeding had a higher median INR compared to patients without rebleeding [1.3 vs. 1.2] (p-value 0.04). The relationship between index bleeding site and rebleeding event was significant as well. In the rebleeding group, the index bleeding site was esophageal in 12% (2/17), gastric in 29% (5/17), and duodenal in 59% (10/17). In comparison, in the non-rebleeding group, the index bleeding site was esophageal in 10% (6/58), gastric in 60% (35/58), and duodenal in 30% (17/58). Association between rebleeding event and clinical/endoscopic characteristics of patients has been shown in the table.

Discussion: Rebleeding group had higher INR and duodenal bleed as compared to no- rebleeding group. Interestingly, restarting DAPT was not associated with the rebleeding group. In our study sample, logistic regression could not be performed due to small event rate of rebleeding and sample size. Further studies in larger patient population should be performed to elucidate risk factors of rebleeding.

Clinical/Endoscopic characteristics	p-value
Number of comorbidities	0.09
Hemoglobin	0.39
Blood urea nitrogen	0.054
International normalized ratio	0.04
activated partial thromboplastin time	0.72
Site of bleed	0.047
Etiology of bleed	0.9
ulcer size >10 mm on endoscopy	0.068
severity of index bleeding as per Forrest classification	0.87
positive H. Pylori status	0.17
restarting DAPT after primary hemostasis	0.94

Table: Title: Association between rebleeding event and clinical/endoscopic characteristics of patients with non-variceal upper gastrointestinal bleed after achieving primary hemostasis
Abbreviations: H.pylori: Helicobacter pylori, DAPT: dual anti-platelet therapy


Disclosures:
Rahul Karna indicated no relevant financial relationships.
Bandhul Hans indicated no relevant financial relationships.
Dhruv Chaudhary indicated no relevant financial relationships.
Manish Dhawan indicated no relevant financial relationships.


Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD. P1527 - Bleeding Site and High INR Are Associated With Rebleeding in Patients on Dual Anti-Platelet Therapy Undergoing Endotherapy for Non-Variceal Upper Gastrointestinal Bleed, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.