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Resuming aspirin in patients with non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis

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Ελληνική Γαστροεντερολογική Εταιρία   

Αποθετήριο :
Annals of Gastroenterology   

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Resuming aspirin in patients with non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis (EN)
Akl, Elie A.
Hashash, Jana
Aoun, Roni
Barada, Kassem
Khamis, Assem
El-Majzoub, Nadim
Rockey, Don
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
2021-05-05
Background Our primary and secondary aims were to analyze the evidence surrounding mortality and re-bleeding risks in patients on aspirin with non-variceal upper gastrointestinal bleeding (NVUGIB) as a function of whether or not aspirin was resumed after the bleeding episode, and to determine whether aspirin intake upon admission affected the outcomes. Methods A search for randomized controlled trials (RCTs) and prospective observational studies was performed. Data extraction and risk of bias assessment were done. Generic inverse variance and random-effects model were employed. Heterogeneity across studies was assessed using the I2 test. Certainty of evidence was assessed using the GRADE approach for each comparison and outcome, and an evidence profile was created. Results Evidence from 1 RCT and 4 observational studies suggests that early aspirin resumption reduced mortality (hazard ratio [HR] 0.20, 95% confidence interval [CI] 0.06-0.63) while increasing re-bleeding risk (HR 1.90, 95%CI 0.60-6.00); moderate certainty of evidence. The observational evidence was inconsistent for both mortality (HR 0.84, 95%CI 0.54-1.33) and re-bleeding (HR 0.85, 95%CI 0.47-1.55); very low certainty of evidence. Nine observational studies addressed our secondary aim: 6 provided inconsistent results regarding mortality (pooled odds ratio [OR] 1.1, 95%CI 0.80-1.50) and 4 provided inconsistent results regarding re-bleeding risk (pooled OR 0.92, 95%CI 0.53-1.59); very low certainty of evidence for both outcomes. Conclusion Evidence supporting a protective effect of aspirin resumption soon after NVUGIB is of low-to-moderate certainty, and is not informative as to the optimal timing of aspirin resumption. Keywords Aspirin, mortality, re-bleeding, non-variceal upper gastrointestinal bleeding Ann Gastroenterol 2021; 34 (3): 344-353 (EN)
Αγγλική γλώσσα
Hellenic Society of Gastroenterology (EN)
1792-7463
1108-7471
Annals of Gastroenterology; Volume 34, No 3 (2021); 344 (EN)
Copyright (c) 2021 Annals of Gastroenterology (EN)
Ελληνική Γαστροεντερολογική Εταιρία
Annals of Gastroenterology
Original Articles



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