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



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.


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 .


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.


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.


Computed tomography angiography Gastrointestinal bleeding Contrast-induced nephropathy 



Chronic kidney disease


Contrast-induced nephropathy


Computed tomography angiography


Gastrointestinal bleeding


Lower gastrointestinal bleeding


Novel oral anticoagulant (direct oral anticoagulant)


Non-steroidal anti-inflammatory drug


Supplementary material

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


  1. 1.
    Laine L, Yang H, Chang SC, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012;107(8):1190-1195; quiz 1196.Google Scholar
  2. 2.
    Tielleman T, Bujanda D, Cryer B. Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):415-428.CrossRefGoogle Scholar
  3. 3.
    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360; quiz 361.Google Scholar
  4. 4.
    Millward SF. ACR Appropriateness Criteria on treatment of acute nonvariceal gastrointestinal tract bleeding. J Am Coll Radiol. 2008;5(4):550-554.CrossRefGoogle Scholar
  5. 5.
    Foley PT, Ganeshan A, Anthony S, Uberoi R. Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention? J Med Imaging Radiat Oncol. 2010;54(1):9-16.CrossRefGoogle Scholar
  6. 6.
    Al-Saeed O, Kombar O, Morsy M, Sheikh M. Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study. J Med Imaging Radiat Oncol. 2011;55(3):252-258.CrossRefGoogle Scholar
  7. 7.
    He B, Yang J, Xiao J, et al. Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis. Eur J Radiol. 2017;93:40-45.CrossRefGoogle Scholar
  8. 8.
    Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016;111(4):459-474.CrossRefGoogle Scholar
  9. 9.
    Thomas ME, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice. Kidney Int. 2015;87(1):62-73.CrossRefGoogle Scholar
  10. 10.
    Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol. 2010;16(31):3957-3963.CrossRefGoogle Scholar
  11. 11.
    Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. J Med Imaging Radiat Oncol. 2008;52(4):333-338.CrossRefGoogle Scholar
  12. 12.
    Junquera F, Quiroga S, Saperas E, et al. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000;119(2):293-299.CrossRefGoogle Scholar
  13. 13.
    Haber ZM, Charles HW, Erinjeri JP, Deipolyi AR. Predictors of Active Extravasation and Complications after Conventional Angiography for Acute Intraabdominal Bleeding. J Clin Med. 2017;6(4).Google Scholar
  14. 14.
    Lee L, Iqbal S, Najmeh S, Fata P, Razek T, Khwaja K. Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes. Can J Surg. 2012;55(6):382-388.CrossRefGoogle Scholar
  15. 15.
    Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation. 2011;123(21):2363-2372.CrossRefGoogle Scholar
  16. 16.
    Cheung KS, Leung WK. Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J Gastroenterol. 2017;23(11):1954-1963.CrossRefGoogle Scholar
  17. 17.
    Wilcox CM, Alexander LN, Cotsonis GA, Clark WS. Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci. 1997;42(5):990-997.CrossRefGoogle Scholar
  18. 18.
    Taki M, Oshima T, Tozawa K, et al. Analysis of risk factors for colonic diverticular bleeding and recurrence. Medicine (Baltimore). 2017;96(38):e8090.CrossRefGoogle Scholar
  19. 19.
    Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34(4):643-664.CrossRefGoogle Scholar
  20. 20.
    Artigas JM, Martí M, Soto JA, Esteban H, Pinilla I, Guillén E. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics. 2013;33(5):1453-1470.CrossRefGoogle Scholar
  21. 21.
    Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the Risk of Radiocontrast-Associated Nephropathy. J Am Soc Nephrol. 2017;28(2):653-659.CrossRefGoogle Scholar
  22. 22.
    Heinrich MC, Häberle L, Müller V, Bautz W, Uder M. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology. 2009;250(1):68-86.CrossRefGoogle Scholar

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

Personalised recommendations