The Impact Of Blood Thinners In The Diagnosis Of Upper Gastrointestinal Tract Malignancy, In Patients With Signs Suggestive Of Upper Gastrointestinal Bleeding

Aims Aim of this study was to analyze the impact of blood thinners in the diagnosis of upper gastrointestinal (GI) tract malignancy, in patients with signs suggestive of upper GI bleeding.

Methods Retrospective study of 393 patients with melena, hematemesis, coffeeground hematemesis or bloody nasogastric aspirate, who had an esophagogastroduodenoscopy in the Gastroenterology Department of the General Hospital of Ioannina, Greece, between January 2019 – October 2023. Data regarding patient treatment and endoscopic findings were retrieved from the electronic patient records. Of the 461 patients initially identified, patients with known gastrointestinal cancer (n:17), variceal bleeding (n:10), or missing data (n:41) were excluded from data analysis. To evaluate the strength of the association between blood thinners and gastric malignancy, a two-by-two contingency table was analyzed and Odds Ratio (OR) was calculated. Subjects were categorized into four categories based on the use, or not, of blood thinners (Exposed, or Non-Exposed, groups) and the diagnosis, or not, of upper GI malignancy.

Results 294 patients (Exposed group; males 186, age 77.37 years old, Std.D 12.27) were on blood thinners (Acetylsalicylic Acid, n:55; Clopidogrel, n:22; Dual Antiplatelet Therapy, n: 20; Triple Therapy, n:4; Direct Oral Anticoagulants, n:99; Acenocoumarol, n: 31; Low Molecular Weight Heparin, n:38; NSAID, n: 25). 99 patients had no record of blood thinners use (Non-Exposed group; males:73, age 59.36 years old, Std.D 21.03). In the exposed group, 21 patients were diagnosed with upper GI malignancy. Other diagnoses were: Non-significant findings, n:103; Gastric Ulcer, n:51; Duodenal Ulcer, n:40; Esophagitis, n:19; Arteriovenous malformation (AVM), n:26; Mallory Weiss Tear (MWT), n:19; Dieulafoy's lesion, n:5; Cameron lesion, n:2; GAVE, n:2; Hyperplastic polyp, n:7; Adenomatous polyp, n:1. In the Non-Exposed group, 9 patients were diagnosed with upper GI malignancy. Other diagnoses were: Non-significant findings, n:27; Gastric Ulcer, n:24; Duodenal Ulcer, n:22; Esophagitis, n:4; MWT, n:11; Cameron lesion, n:1; Hyperplastic polyp, n: 1. The OR for the diagnosis of upper GI malignancy, polyps and vascular lesions (AVM, Dieulafoy's lesion, GAVE) were 0.79 [(95% CI: 0.35 to 1.77) P=0.56],2.75 [(95% CI: 0.34 to 22.27), P=0.34] and 25.5 [(95% CI: 1.55 to 420.07), P=0.02], respectively. [1] [2]

Conclusions A strong association between blood thinners and the diagnosis of vascular lesions was identified. However, no significant statistical difference was identified regarding the diagnostic rate of upper GI malignancy or polyps between the exposed and non-exposed to blood thinners groups.

Publication History

Article published online:
15 April 2024

• References

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