J Stroke.  2025 Jan;27(1):102-112. 10.5853/jos.2024.00661.

Long-Term Incidence of Gastrointestinal Bleeding Following Ischemic Stroke

• Kim JY
• Kim BJ
• Kang J
• Kim DY
• Han MK
• Kim SE
• Lee H
• Park JM
• Kang K
• Lee SJ
• Kim JG
• Cha JK
• Kim DH
• Park TH
• Lee K
• Park HK
• Cho YJ
• Hong KS
• Choi KH
• Kim JT
• Kim DE
• Choi JC
• Oh MS
• Yu KH
• Lee BC
• Park KY
• Lee JS
• Jang S
• Chae JE
• Lee J
• Kye MS
• Gorelick PB
• Bae HJ
• on Behalf of the CRCS-K Investigators

• KMID: 2564267
• DOI: http://doi.org/10.5853/jos.2024.00661

Abstract

Background and Purpose
Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes.
Methods
We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data.
Results
Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m² , and a 3-month modified Rankin Scale score of ≥4.
Conclusion
Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Keyword

Gastrointestinal bleeding; Ischemic stroke; Medical complications

Figure

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  Figure 1. Time distribution of major gastrointestinal bleeding events following acute ischemic stroke. Major gastrointestinal bleeding was defined as bleeding leading to the transfusion of two or more units of whole blood or red blood cells.

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  Figure 2. Cumulative incidence function for major gastrointestinal bleeding following acute ischemic stroke.

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  Figure 3. Adjusted IRR (95% CI) of selected variables for major GI bleeding following acute ischemic stroke. GI, gastrointestinal; NIHSS, National Institutes of Health Stroke Scale; IV tPA, intravenous tissue plasminogen activator; NSAID, nonsteroidal anti-inflammatory drug; eGFR, estimated glomerular filtration rate; ASA, aspirin; AP, antiplatelet; AC, anticoagulant; mRS, modified Rankin Scale; IRR, incidence rate ratio; CI, confidence interval.

Reference

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