GI Bleeding After Stroke Raises Death Risk

WEDNESDAY Aug. 6, 2008 -- Stroke patients who develop gastrointestinal bleeding while in recovery are three times as likely to die in the hospital or be heavily disabled upon release than those who do not, a new Canadian study suggests.

The finding is based on an analysis of patients who were observed while in recovery from an ischemic stroke. Ischemic strokes are the most common type of stroke -- resulting from a slowdown or blockage of blood to the brain.

"We found that the actual incidence of gastrointestinal [GI] bleeding would make it an uncommon complication," said study author Dr. Martin O'Donnell, an associate professor in the department of medicine at McMaster University in Hamilton, Ontario. "But when it does arise, it appears to be associated with increased death and disability."

O'Donnell and his colleagues are publishing their findings in the Aug. 6 online issue of Neurology.

The authors focused on just over 6,800 men and women admitted to 11 Ontario hospitals between 2003 and 2006 following an acute ischemic stroke.

Of these patients, 829 died during their hospital stay, and 1,374 passed away within six months of their stroke.

Just 1.5 percent -- or 100 patients -- had bleeding in their stomach or intestine during their hospitalization. These patients were evenly split among men and women, and more than half had experienced a mild or moderate stroke, the research team noted.

Aside from a tripling of mortality in the hospital, stroke patients with GI bleeding were also 1.5 times more likely to die within a half-year of their stroke than those with no such complication. This observation held up even after accounting for other factors that could contribute to mortality, such as pneumonia and heart attacks.

O'Donnell noted that the relatively small number of patients he and his team tracked makes it difficult to definitively identify what type of stroke patients are at highest risk for GI bleeding -- although that is something he and his colleagues hope to explore down the road. But meanwhile, he argued that the findings already highlight some critical issues concerning stroke recovery.

"One of the key points we want to raise is that people are generally prone to developing medical complications with stroke," he said. "And as part of that larger observation, we know that among these complications are GI issues. And we feel that this is particularly important, because gastrointestinal bleeding is a complication that is potentially modifiable with various treatment strategies."

However, both Dr. Matthew Fink, chief of the division of stroke and critical care neurology at Weill Cornell Medical College in New York City, and Dr. Larry B. Goldstein, director of The Stroke Center at Duke University Medical Center, expressed reservations about the findings.

"Having a poorer outcome in stroke patients with gastrointestinal bleeding is not surprising at all," said Goldstein. "But I don't know, based on this kind of a retrospective study, if we can tell how preventable this is, as there are all sorts of things that the researchers may not be measuring that might affect the results."

Fink agreed, while suggesting that the issue itself is not particularly pressing.

"In the U.S.," he noted, "we treat all our stroke patients with preventive prophylactic therapy to prevent GI bleeding, and our experience is that GI bleeding is a rare event. So, it's really not something we get too concerned about."

"And that means that the fact that this study shows an increased risk of death associated with GI bleeding says to me that a gastrointestinal problem is simply a marker for someone who is a lot sicker, not an independent factor directly related to the stroke itself," he said. "So, I don't think this finding gives us much useful new information."

More information

For more on post-stroke recovery, visit the National Stroke Association.

Posted: August 2008


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