Gastrointestinal bleeding after stroke may increase risk of death

People who have gastrointestinal (GI) bleeding after a stroke are more likely to die or become severely disabled than stroke sufferers with no GI bleeding, according to a study published in the August 6, 2008, online issue of Neurology, the medical journal of the American Academy of Neurology.

“This is an important finding since there are effective medications to reduce gastric acid that can lead to upper gastrointestinal bleeding,” said study author Martin O’Donnell, MB, of McMaster University in Hamilton, Ontario. “More research will be needed to determine whether this is a viable strategy to improve outcomes after stroke in high-risk patients.”

The study involved 6,853 people who had ischemic strokes. The most common type of stroke, ischaemic strokes occur when blood flow to the brain is reduced or blocked. Of those, 829 people died during their hospital stay and 1,374 had died within six months after the stroke.

A total of 100 people, or 1.5 percent, had gastrointestinal bleeding, or bleeding in the stomach or intestines, while they were in the hospital from the stroke. In more than half of the cases, the GI bleeding occurred in people who had mild to moderate strokes.

The people with GI bleeding were more than three times more likely to die during their hospital stay or be severely dependent on others for their care at the time they left the hospital than people who did not have GI bleeding. A total of 81 percent of those with GI bleeding died in the hospital or were severely dependent, compared to 41 percent of those without GI bleeding.

Those with GI bleeding were also 1.5 times more likely to have died within six months after the stroke than those without GI bleeding. Of those with GI bleeding, 46 percent had died within six months, compared to 20 percent of those without GI bleeding. This relationship remained even after researchers adjusted for other factors, including other conditions such as pneumonia and heart attack.

The study was supported by the Canadian Stroke Network, the Ontario Ministry of Health and Long-term Care, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences and the University Health Network Women’s Health Program in Toronto.

(Source: Neurology: American Academy of Neurology: September 2008)