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Recent use of NSAID and NOAC medications are associated with a positive CT arteriogram

  • Muhammad A. Shafqet
  • Alexander Tonthat
  • Paola Esparragoza
  • Butros Toro
  • Adam C. Ehrlich
  • Frank K. FriedenbergEmail author
Interventional Radiology
  • 33 Downloads

Abstract

Background

Computed tomography angiography (CTA) is a diagnostic modality utilized in patients with suspected active lower gastrointestinal (GI) bleeding. CTA use in clinical practice is limited by the risk of contrast-induced nephropathy, and the loss of patients from direct physician observation while undergoing the test. Identifying clinical predictors of a positive result would be useful in guiding physician utilization of CTA studies.

Methods

We performed a single-center retrospective study to determine which clinical predictors are associated with a positive CTA. Binary logistical regression modeling was used to identify the independent predictors and the results were expressed as adjusted odds ratios with corresponding 95% CI .

Results

262 patients met inclusion criteria and there were 61 (23.3%) positive CTA exams. In unadjusted analysis those who were CTA positive were more likely to require management in the intensive care unit (85.2% vs. 14.8%, p < 0.01) and being CTA positive was associated with a significantly increased in-hospital mortality (14.8% vs. 4.5%, p < 0.01). The use of a novel oral anticoagulant (NOAC) in the week prior to presentation was associated with a positive CTA after adjustment for confounders (adjusted odds ratio = 3.89; 95% CI 1.05–14.43). Similarly, the use of a non-steroidal anti-inflammatory drug (NSAID) was associated with a positive CTA (OR 2.36; 1.03–5.41). Only 8% of patients experienced contrast-induced nephropathy.

Conclusion

Use of either NOACs or NSAIDs in the previous week is independently associated with a positive CTA in the setting of acute lower GI bleeding. CTA exams appear to confer a low risk of contrast-induced nephropathy.

Keywords

Computed tomography angiography Gastrointestinal bleeding Contrast-induced nephropathy 

Abbreviations

CKD

Chronic kidney disease

CIN

Contrast-induced nephropathy

CTA

Computed tomography angiography

GIB

Gastrointestinal bleeding

LGIB

Lower gastrointestinal bleeding

NOAC (DOAC)

Novel oral anticoagulant (direct oral anticoagulant)

NSAID

Non-steroidal anti-inflammatory drug

Notes

Supplementary material

261_2019_2005_MOESM1_ESM.xlsx (10 kb)
Supplementary material 1 (XLSX 11 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Gastroenterology and HepatologyLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  2. 2.School of MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  3. 3.Department of MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA

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