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Risk factors for anticoagulant-associated gastrointestinal hemorrhage: a systematic review and meta-analysis
Fuxin Ma1, Shuyi Wu1, Shiqi Li1
1Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Insights
New research identifies key risk factors for gastrointestinal bleeding in patients taking anticoagulants. Anemia and heart failure are among the newly identified predictors, improving risk assessment for anticoagulant-associated gastrointestinal bleeding.
Area of Science:
- Pharmacology and Therapeutics
- Gastroenterology
- Clinical Risk Prediction
Background:
- Anticoagulation therapy is crucial but carries a risk of gastrointestinal bleeding (GIB).
- Existing risk prediction models for anticoagulant-associated GIB may not encompass all significant factors.
- Systematic reviews and evidence certainty assessments for these risk factors were previously lacking.
Conclusions:
- Anemia, specific drug interactions (gemfibrozil, verapamil, diltiazem), INR, heart failure, and myocardial infarction are significant predictors of anticoagulation-related GIB.
- These identified factors are not fully incorporated into existing risk prediction models.
- Findings will enhance GIB risk prediction, inform prevention guidelines, and guide future research in anticoagulation management.
Background/Aims:
There may be many predictors of anticoagulation-related gastrointestinal bleeding (GIB), but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify all risk factors for anticoagulant-associated GIB to inform risk prediction in the management of anticoagulation- related GIB.
Methods:
A systematic review and meta-analysis were conducted to search PubMed, EMBASE, Web of Science, and Cochrane Library databases (from inception through January 21, 2022) using the following search terms: anticoagulants, heparin, warfarin, dabigatran, rivaroxaban, apixaban, DOACs, gastrointestinal hemorrhage, risk factors. According to inclusion and exclusion criteria, studies of risk factors for anticoagulation-related GIB were identified. Risk factors for anticoagulant-associated GIB were used as the outcome index of this review.
Results:
We included 34 studies in our analysis. For anticoagulant-associated GIB, moderate-certainty evidence showed a probable association with older age, kidney disease, concomitant use of aspirin, concomitant use of the antiplatelet agent, heart failure, myocardial infarction, hematochezia, renal failure, coronary artery disease, helicobacter pylori infection, social risk factors, alcohol use, smoking, anemia, history of sleep apnea, chronic obstructive pulmonary disease, international normalized ratio (INR), obesity et al. Some of these factors are not included in current GIB risk prediction models. such as anemia, co-administration of gemfibrozil, co-administration of verapamil or diltiazem, INR, heart failure, myocardial infarction, etc.
Conclusion:
The study found that anemia, co-administration of gemfibrozil, co-administration of verapamil or diltiazem, INR, heart failure, myocardial infarction et al. were associated with anticoagulation-related GIB, and these factors were not in the existing prediction models. This study informs risk prediction for anticoagulant-associated GIB, it also informs guidelines for GIB prevention and future research.
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