Esophagogastroduodenoscopy findings in patients with or without recent use of antiplatelets, anticoagulants, or NSAIDs and non-variceal upper gastrointestinal bleeding: A retrospective cohort study.

Background: Use of antiplatelets, anticoagulants, or aspirin/NSAIDs increases the risk of major gastrointestinal (GI) bleeding. This study aimed to analyze esophagogastroduodenoscopy (EGD) findings in patients treated with these drugs (drug-exposed) versus those who were not (non-exposed), who presented with signs suggestive of nonvariceal upper GI bleeding.

Patients and methods: This retrospective cohort study included patients aged over 16 years with signs suggestive of upper GI bleeding, no history of gastrointestinal malignancy, and no portal hypertension or varices, hospitalized at the General Hospital of Ioannina, Greece, from January 2019 to October 2023. Differences between the two patient groups were tested for significance with the chi-square test. Relative Risk (RR) and Odds Ratio (OR) were calculated to assess the association between drug exposure and endoscopic findings. A p-value less than 0.05 was consider ed statistically significant.

Results: A total of 405 patients (268 males; mean age 73.1 ± 16.8 years) were enrolled: 303 drug-exposed (193 males; mean age 77.6 ± 12.2) and 102 non-exposed (75 males; mean age 59.7 ± 20.9). Peptic ulcer disease (PUD) was the most common bleeding cause. Drug exposure was strongly associated with vascular lesions (angiodysplasias, Dieulafoy's lesion, GAVE) (RR: 12.12, 95% CI: 1.68-87.3, p = 0.01; OR: 13.62, 95% CI: 1.84-100.64, p = 0.002). Notably, 75% of angiodysplasia cases occurred in anticoagulant-treated patients, with 50% receiving DOACs.

Conclusion: Upper GI bleeding in patients on antiplatelets, anticoagulants, or NSAIDs/aspirin should prompt suspicion of pre-existing lesions, particularly PUD and angiodysplasias.