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Acute gastroduodenal lesions in patients with venous thromboembolism. Identification of patients at risk.

The prime complication of heparin therapy is bleeding, and the gastrointestinal tract is the most common site of bleeding in patients treated with heparin. We recently reported that gastroduodenal lesions are common in patients admitted because of acute venous thromboembolism, and now we present our experience in a larger series of patients. The aims of the study were to try to validate our previous findings and to identify clinical factors that could increase the likelihood of having an acute, potential bleeding lesion in the gastroduodenal tract. Upper gastrointestinal endoscopy was performed on admission in 155 consecutive patients with acute venous thromboembolism (118 with deep vein thrombosis, 37 with pulmonary embolism). Acute lesions (both peptic ulcers and diffuse erosions) were found in 19 of 118 patients (16 percent) with venous thrombosis, and in 14 of 37 patients (38 percent) with pulmonary embolism (p = 0.005). When only patients with pulmonary embolism were considered, lesions were more commonly found in men, and in patients with severe hypoxemia on admission. When considered overall, only the timing of endoscopy was statistically significant; acute lesions were more commonly found when endoscopy was performed early after admission. No significant differences were found in terms of age, sex, smoking habits, alcohol intake, concomitant drug ingestion, comorbid diseases, or previous history of ulcer. The very high incidence of upper GI tract lesions in these patients will have long-term diagnostic/therapeutic implications which cannot be ignored. Who should receive prophylactic H2 blockers and for how long remains to be determined.