GASTROINTESTINAL HEMORRHAGE AFTER ACUTE STROKE

Background and Purpose Although patients with critical illness or acut e head injury are known to be at risk of gastrointestinal hemorrhage, there is little information concerning acute stroke. We sought to reco rd the frequency, possible causes, and course of gastrointestinal hemo rrhage in a cohort of hospitalized stroke patients. Methods During a 3 6-month period we prospectively identified 613 strokes (excluding suba rachnoid hemorrhage). We then retrieved the case notes, and a single o bserver reviewed all available records (n=607), noting any episodes of gastrointestinal hemorrhage together with details concerning the cour se, possible precipitating factors, management, and outcome. Results E ighteen patients (3%) experienced a gastrointestinal hemorrhage, half of which were severe. These patients were older and had suffered more severe strokes than those without any gastrointestinal bleeding. The s ource was identified in 5 patients; 2 had gastric ulceration, 2 duoden al ulceration, and the remaining one had esophageal/duodenal ulceratio n. In 17 patients there was a potential risk factor for hemorrhage, al though the odds ratios comparing the use of antithrombotic drugs in th e hemorrhage and nonhemorrhage groups did not achieve statistical sign ificance. Death during the acute admission period was more common in t he 18 hemorrhage patients (odds ratio, 4.6; 95% confidence interval, 1 .7 to 13.2; two-tailed P=.002, Fisher's exact Lest); of the 10 who die d, gastrointestinal hemorrhage appeared to have been a contributing fa ctor in 3. Conclusions Our study provides a reasonably accurate estima te of the frequency of gastrointestinal hemorrhage after acute stroke. The higher frequency found in our study than the previously published data is probably due to study methodology. Older patients with more s evere strokes may be at increased risk of this complication, and it ma y adversely affect outcome.