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Published on: May 11, 2011
Risk of gastrointestinal rebleeding in direct oral anticoagulant-treated population
Bianca Codrina Morarasu1,2, Victorita Sorodoc1,2, Constantin Simiras3
1Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii 16, 700111 Iasi, Romania.
Insights
Previous gastrointestinal bleeding (GIB) significantly increases rebleeding risk in patients on direct oral anticoagulants (DOACs). Close follow-up is crucial for high-risk patients, as DOAC management strategy did not impact rebleeding rates.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are widely used for anticoagulation.
- Gastrointestinal bleeding (GIB) is a serious complication in patients on anticoagulation.
- Understanding rebleeding risk after GIB is critical for patient management.
Purpose of the Study:
- To analyze rebleeding events in patients experiencing GIB while on DOACs.
- To compare DOAC discontinuation versus resumption strategies regarding rebleeding risk.
- To identify risk factors associated with recurrent GIB in DOAC-treated patients.
Main Methods:
- Retrospective analysis of 120 patients admitted with GIB between January 2018 and December 2022.
- Patients were categorized based on anticoagulant management at discharge and subsequent bleeding events.
- Follow-up extended to 6 months or until death, last contact, or event occurrence.
Main Results:
- A history of GIB was the most significant predictor of rebleeding (29.6% vs. 6.4%).
- Patients with prior GIB had a 4-fold increased risk of rebleeding within the first 15.2 months.
- Higher HAS-BLED scores (>3) were associated with DOAC discontinuation.
Conclusions:
- Previous GIB is the primary risk factor for recurrent bleeding in DOAC users, especially within the first 15 months.
- Patients aged ≥75, with diabetes, malignancy, or high HAS-BLED scores require vigilant monitoring.
- Anticoagulation resumption timing and DOAC agent choice did not affect rebleeding rates, underscoring DOACs' established benefits.
Introduction:
We performed a retrospective analysis of rebleeding events and their association with direct oral anticoagulant (DOAC) discontinuation versus resumption in patients admitted with an index episode of gastrointestinal bleeding (GIB) while on oral anticoagulants.
Materials And Methods:
We included patients ≥18 years between January 2018 and December 2022. The cohort was divided into two groups, initially based on anticoagulant management at discharge, subsequently, according to bleeding events during follow-up, which ended at the time of death, last clinical contact, time of the event, or within 6 months since last patient was included.
Results:
A total of 120 patients were included. Those with HAS-BLED score > 3 were more likely discontinue DOAC (P = 0.0009). Significantly more patients with previous GIB had a rebleeding episode (29.6% vs. 6.4%, P = 0.002) and a 4-fold higher risk of rebleeding in the first 15.2 months (HR 4.070, CI [1.771-9.354], P = 0.001). A history of diabetes mellitus, malignancy, CHA2DS2-VASc, and HAS-BLED score > 3 was associated with an increased rebleeding risk, but without statistical significance.
Conclusion:
Previous episode of GIB is the most significant risk factor for recurrent bleeding in DOAC-treated patients. It leads to a four times higher risk of bleeding, particularly in the first 15 months. Patients aged ≥75, with a history of diabetes mellitus, malignancy, and HAS-BLED score > 3 should be closely followed-up. Timing of anticoagulation resumption and specific DOAC agent did not influence the rate of rebleeding, supporting their proven benefit.
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