PMID- 32795156
OWN - NLM
STAT- MEDLINE
DCOM- 20210719
LR  - 20210719
IS  - 1365-2060 (Electronic)
IS  - 0785-3890 (Print)
IS  - 0785-3890 (Linking)
VI  - 52
IP  - 7
DP  - 2020 Nov
TI  - Clinical and pharmacological characteristics of elderly patients admitted for 
      bleeding: impact on in-hospital mortality.
PG  - 413-422
LID - 10.1080/07853890.2020.1808238 [doi]
AB  - INTRODUCTION: Clinical and pharmacological characteristics of elderly patients 
      hospitalized for bleeding and in-hospital mortality according to bleeding type 
      are barely described. METHODS: Retrospective cohort study of 13,496 consecutive 
      patients admitted to internal medicine wards. Clinical characteristics, 
      comorbidities and pharmacological treatments were collected for each patient. 
      Predictors of in-hospital mortality were investigated. RESULTS: Overall, 531 
      (3.9%) patients were admitted for bleeding: 189 clinically relevant non-major 
      bleeding, 106 cerebral and 236 major non-cerebral (95.8% gastrointestinal (GI)). 
      Among 106 cerebral bleedings, 28.3% and 24.5% were typical and atypical 
      intracranial, respectively, and 47.2% were subdural haemorrhages. Most of 
      patients with GI bleeding presented with anaemia (90.7%). A similar rate of GI 
      bleeding was found in aspirin-treated patients taking or not proton pump 
      inhibitors (PPI). In-hospital mortality was 9.98%. Age >/=80 years (odds ratio (OR) 
      2.513, p=.005), cerebral bleeding (OR 5.373, p<.001), eGFR <30 ml/min/m(2) (OR 
      2.388, p=.035) and COPD (OR 2.362, p=.024) were positively associated with 
      mortality, while ACE inhibitors/ARBs use was negatively associated (OR 0.383, 
      p=.028). CONCLUSIONS: The most frequent type of major haemorrhage was GI 
      bleeding, which was not modified by the use of PPI in patients taking aspirin. 
      Cerebral bleeding increased all-cause death, which was lower in ACE 
      inhibitors/ARBs users. KEY MESSAGE Gastrointestinal (GI) bleeding was the most 
      common reason for hospital admission. The rate of GI bleeding was similar in 
      patients on aspirin using or not PPI. Cerebral bleeding increased in-hospital 
      mortality, which was lower in patients taking ACE inhibitors/ARBs.
FAU - Pani, Arianna
AU  - Pani A
AD  - Department of Oncology and Onco-Hematology, Postgraduate School of Clinical 
      Pharmacology and Toxicology, University of Milan, Milan, Italy.
AD  - Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale 
      Metropolitano Niguarda, Milan, Italy.
FAU - Pastori, Daniele
AU  - Pastori D
AD  - Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, I 
      Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Rome, 
      Italy.
FAU - Senatore, Michele
AU  - Senatore M
AD  - Department of Oncology and Onco-Hematology, Postgraduate School of Clinical 
      Pharmacology and Toxicology, University of Milan, Milan, Italy.
AD  - Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale 
      Metropolitano Niguarda, Milan, Italy.
FAU - Romandini, Alessandra
AU  - Romandini A
AD  - Department of Oncology and Onco-Hematology, Postgraduate School of Clinical 
      Pharmacology and Toxicology, University of Milan, Milan, Italy.
AD  - Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale 
      Metropolitano Niguarda, Milan, Italy.
FAU - Colombo, Giulia
AU  - Colombo G
AD  - Internal Medicine Department, Policlinico Maggiore Ca' Granda, Milan, Italy.
FAU - Agnelli, Francesca
AU  - Agnelli F
AD  - Internal Medicine Department, Azienda Socio-Sanitaria Territoriale Grande 
      Ospedale Metropolitano Niguarda, Milan, Italy.
FAU - Scaglione, Francesco
AU  - Scaglione F
AD  - Department of Oncology and Onco-Hematology, Postgraduate School of Clinical 
      Pharmacology and Toxicology, University of Milan, Milan, Italy.
AD  - Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale 
      Metropolitano Niguarda, Milan, Italy.
FAU - Colombo, Fabrizio
AU  - Colombo F
AD  - Internal Medicine Department, Azienda Socio-Sanitaria Territoriale Grande 
      Ospedale Metropolitano Niguarda, Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20200818
PL  - England
TA  - Ann Med
JT  - Annals of medicine
JID - 8906388
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anemia/etiology
MH  - Angiotensin Receptor Antagonists
MH  - Angiotensin-Converting Enzyme Inhibitors
MH  - Anticoagulants/adverse effects
MH  - Aspirin/adverse effects
MH  - Cerebral Hemorrhage/diagnosis/epidemiology/*mortality
MH  - Comorbidity
MH  - Female
MH  - Gastrointestinal Hemorrhage/*chemically induced/diagnosis/epidemiology/*mortality
MH  - Hemorrhage/diagnosis/*drug therapy/epidemiology/mortality
MH  - Hospital Mortality/*trends
MH  - Hospitalization
MH  - Humans
MH  - Italy/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - Predictive Value of Tests
MH  - Prevalence
MH  - Protective Factors
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Retrospective Studies
PMC - PMC7877962
OTO - NOTNLM
OT  - ACE inhibitors
OT  - Elderly
OT  - PPI
OT  - anticoagulants
OT  - antiplatelet
OT  - bleeding
OT  - cerebral
OT  - gastrointestinal
OT  - mortality
OT  - sartans
COIS- All authors declare no conflicts of interest related to the manuscript.
EDAT- 2020/08/17 06:00
MHDA- 2021/07/20 06:00
PMCR- 2020/08/18
CRDT- 2020/08/16 06:00
PHST- 2020/08/17 06:00 [pubmed]
PHST- 2021/07/20 06:00 [medline]
PHST- 2020/08/16 06:00 [entrez]
PHST- 2020/08/18 00:00 [pmc-release]
AID - 1808238 [pii]
AID - 10.1080/07853890.2020.1808238 [doi]
PST - ppublish
SO  - Ann Med. 2020 Nov;52(7):413-422. doi: 10.1080/07853890.2020.1808238. Epub 2020 
      Aug 18.