D0302 - Hospital Outcomes in Patients With Gastrointestinal Bleeding on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis

Dennis Shung, MD, MHS, PhD, Darrick K. Li, MD, PhD
Yale University School of Medicine, New Haven, CT

Introduction: Low-dose aspirin monotherapy (ASA) is widely used for primary prevention of atherosclerotic cardiovascular disease (ASCVD). While ASA is a known risk factor for upper gastrointestinal bleeding (UGIB), little is known regarding in-hospital outcomes in primary prevention ASA users presenting with UGIB. We sought to describe trends in proportion and etiology of primary prevention ASA users presenting with UGIB and investigate the age-dependent impact of ASA on hospital outcomes compared to ASA nonusers.

Methods: Patients ≥40 years old presenting with UGIB were identified in the Nationwide Emergency Department Sample for 2016-2019 using ICD-10 codes. Patients were on primary prevention ASA if they had an ICD-10 code for long-term ASA monotherapy but no ICD-10 codes for ASCVD. In-hospital outcomes included emergency department (ED) discharge, red blood cell (RBC) transfusion, endoscopic hemostatic intervention, and in-hospital mortality. Multivariate weighted regressions were adjusted for gender, geographic region, zip income quartile, primary insurance payer, year, Charlson Comorbidity Index, and urban/rural or teaching hospital status.

Results: From 2016-2019, the overall proportion of patients presenting with acute UGIB to the ED on primary prevention ASA increased (p< 0.001). The most frequent cause of UGIB was peptic ulcer disease. ASA users were less likely to be discharged from the ED (OR 0.67, 95% CI 0.62-0.73), more likely to get RBC transfusion (OR 1.17, 95% CI 1.12-1.22), and more likely to require endoscopic hemostatic intervention (OR 1.14, 95% CI 1.09-1.20) compared to ASA nonusers (Table 1). ASA use decreased overall odds of all-cause in-hospital mortality (OR 0.58 95% CI 0.49-0.70). When stratified by age, the decreased odds of ED discharge was p< 0.01 for all ages, whereas the RBC transfusion reached p< 0.01 starting at ≥50 years old, and endoscopic hemostatic intervention reached p< 0.01 at ≥60 years old.

Discussion: ASA use was independently associated with decreased odds of ED discharge and increased odds of RBC transfusion and need for endoscopic hemostasis among patients on primary prevention ASA presenting to the ED with UGIB. All three outcomes became significant in patients ≥60 years old, supporting recent guidelines recommending against primary prevention ASA in such patients. This data provides patients and clinicians with additional data to assist in risk-benefit discussions for prophylactic ASA.



Disclosures:


Dennis Shung, MD, MHS, PhD, Darrick K. Li, MD, PhD. D0302 - Hospital Outcomes in Patients With Gastrointestinal Bleeding on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.