Gastrointestinal Bleeding After Stroke Linked to Increased Mortality Risk

Gastrointestinal (GI) hemorrhage during the hospital stay after an acute ischemic stroke is associated with a three-fold increase in the risk for death and severe dependence at discharge, according to a new study.

Researchers at McMaster University (Hamilton, ON, Canada) used data from the Registry of the Canadian Stroke Network to look at the incidence of and risk factors for gastrointestinal bleeding, as well as its association with clinical outcomes after ischemic stroke. Stroke severity was measured using the Canadian Neurological Scale; patient dependence after discharge was measured using the modified Rankin Scale (mRS), with a score of 0 to 3 considered no or mild to moderate dependence and a mRS of 4 to 6 encompassing death or severe dependence

The study results showed that of 6,853 patients, 829 died during hospitalization and 1,374 had died by 6 months following surgery. One hundred (1.5%) patients had a GI hemorrhage during their hospitalization, 36 (0.5%) of whom required transfusion. Analysis of the results showed that GI bleeding was associated with death or severe dependence at hospital discharge and with mortality at 6 months, independent of comorbidities and in-hospital medical complications. The researchers also found an increase in the risk for death at 6 months associated with GI hemorrhage during the initial hospital stay. The study was published in the August 26, 2008, issue of Neurology.

"The association between gastrointestinal bleeding and poorer clinical outcomes is likely to be multifactorial,” said lead author Martin O'Donnell, M.B., Ph.D. "For example, when patients experience major bleeding, their antithrombotic therapy is usually stopped, which increases their risk of recurrent major vascular events.”

"If we can identify patients who are at high risk of gastrointestinal bleeding after stroke, particularly upper-GI bleeding, one potential avenue of research would be to determine whether routine prophylactic use of acid-suppression therapies such as H2 antagonists or proton pump inhibitors in this high-risk group would have a beneficial effect on clinical outcomes,” concluded the authors.

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