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Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who
Jihye Park1,2, Jin Su Kim3, Joo Hye Song4
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Background And Aim:
The impact of different anti-thrombotic agents on patients with suspected small bowel bleeding (SSBB) who underwent balloon-assisted enteroscopy (DAE) is unclear. We aimed to examine the clinical effects and predictive factors of DAE based on the thromboembolic agents used.
Methods:
We enrolled 399 patients with SSBB from a web-based DAE registry across 30 medical centers in South Korea. Among them, 291 patients did not receive anti-thrombotic agents, whereas 80, 22, and 6 patients received anti-platelet agents, direct oral anti-coagulants (DOACs), and warfarin, respectively.
Results:
Diagnostic yields were similar across groups; however, therapeutic yields differed: 25.4%, 37.5%, 63.6%, and 83.3% in patients treated with no anti-thrombotic agents, anti-platelets, DOACs, and warfarin, respectively (p < 0.001). The multivariable logistic regression revealed that patients treated with DOACs and warfarin experienced significantly higher therapeutic yields (odds ratio [OR]: 2.803 and 9.526, respectively; 95% confidence interval [CI]: 1.048-7.500 and 1.061-85.481, respectively; p = 0.040 and 0.044, respectively) than those treated with no anti-thrombotic agents. The re-bleeding rates in patients treated with no anti-thrombotic agents, anti-platelets, DOACs, and warfarin were 9.6%, 6.3%, 13.6%, and 50.0%, respectively (p = 0.069). In the multivariable logistic regression analysis, patients treated with warfarin exhibited higher re-bleeding rates than those not treated with anti-thrombotic agents (OR: 9.393, 95% CI: 1.809-48.764, p = 0.008).
Conclusions:
The diagnostic yield of DAE did not differ based on the anti-thrombotic agent type, whereas the therapeutic yield of DAE in DOAC and warfarin users was high. Careful monitoring for re-bleeding is advised in DOAC as well as warfarin users.
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