S1351 Shielding Effects of Antiplatelets on Hospital Outcomes in Non-Variceal Upper Gastrointestinal Bleeding

Introduction: To investigate the potential effects of aspirin use on in hospital metrics and clinical outcomes who were admitted with a principal diagnosis of non-variceal upper gastrointestinal bleeding (NVUGB). Methods: The Nationwide Inpatient Sample, NIS, database from 2017 to 2022 was analyzed for patients age >18 years who were hospitalized with a principal diagnosis of non-variceal upper gastrointestinal bleeding using ICD-10 diagnostic codes. Multivariate logistic regression was applied to the outcomes. The Charlson Comorbidity Index was used to adjust for confounders. A P-value (pv) of < 0.05 was considered statistically significant. The principal outcome of this investigation is in-hospital mortality, with secondary outcomes including length of stay, LOS, total hospital charges, THC, and likelihood of developing hospital complications. Results: The proportion of hospitalized patients with NVUGB who did not use aspirin and died was measured to be 2.14% as compared to 1.06% with aspirin use (P < 0.0001). Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio [aOR] 0.433, 95% confidence interval [CI] 0.395-0.475; P < 0.0001). Patients with aspirin use experienced a shorter, LOS, (1.84 days, 95% CI: -0.863 – -0.776, P < 0.0001) vs 2.66 days without aspirin use, decreased, THC, (-$11431.31, 95% CI: -$12,135.47 to -$10,727.15, P = 0.000). Furthermore, patients with concurrent aspirin use also demonstrated significantly reduced odds of requiring hemodynamic support with vasopressors in setting of NVUGB (aOR 0.67, 95% CI: 0.6039 - 0.7518, P < 0.001) and experienced decreased odds of requiring an ICU level of care (aOR 0.59, 95% CI: 0.564 to 0.625, P < 0.001). Conclusion: Patients admitted with NVUGB with concurrent use of the antiplatelet agent aspirin demonstrated a significantly reduced risk of in-hospital mortality, reduced risk of mortality greater than 56%. Aspirin use in the setting of NVUGB was further linked to decreased LOS and reduced total hospital charges with a significant reduction in odds of developing hemodynamic instability necessitating pressor support and/or ICU level monitoring. These findings reveal that aspirin exerts shielding protective effects against adverse in-hospital outcomes as compared to patients with NVUGB and no concurrent aspirin use.