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The Relationship Between Blood Parameters and Gastrointestinal Bleeding in Atrial Fibrillation Patients Receiving

Hayrullah Yurdakul1, Muhammet Cakas2, Seda Elcim Yildirim3

  • 1Nizip City Hospital, 27300 Gaziantep, Turkey.

Journal of Clinical Medicine
|November 13, 2025
PubMed

Insights

Systemic inflammatory markers predict gastrointestinal bleeding risk in atrial fibrillation (AF) patients on oral anticoagulants (OACs). These markers, especially in non-vitamin K antagonist oral anticoagulant (NOAC) users, can improve risk stratification and personalize OAC therapy.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Atrial fibrillation (AF) necessitates oral anticoagulant (OAC) therapy to prevent stroke but increases gastrointestinal (GI) bleeding risk.
  • Accurate risk stratification for GI bleeding in AF patients on OACs is crucial, particularly in the emergency department (ED).
  • Existing risk scores may not fully capture bleeding risk in patients receiving warfarin or non-vitamin K antagonist oral anticoagulants (NOACs).

Purpose of the Study:

  • To evaluate systemic inflammatory markers as predictors of GI bleeding in AF patients treated with OACs.
  • To compare the predictive value of inflammatory indices between NOAC and warfarin users.
  • To explore the utility of inflammatory markers in refining GI bleeding risk stratification for personalized anticoagulation strategies.

Main Methods:

  • Retrospective cohort study of 155 AF patients in an ED setting (2019-2023).
  • Patients divided into GI bleeding (case) and no GI bleeding (control) groups.
  • Analysis included demographics, comorbidities, CHA2DS2-VASc, HAS-BLED scores, and inflammatory indices (uric acid/albumin ratio, NLR, PLR, SII).

Main Results:

  • In NOAC users, higher uric acid/albumin ratio, NLR, PLR, and SII were significantly associated with GI bleeding (p < 0.05).
  • In warfarin users, only the uric acid/albumin ratio was significantly elevated in the bleeding group (p < 0.001).
  • HAS-BLED scores were higher in bleeding groups; specific factors like hypolipidemia predicted bleeding in NOAC users, while hypoalbuminemia predicted bleeding in warfarin users.

Conclusions:

  • Systemic inflammatory indices, particularly in NOAC users, show promise for stratifying GI bleeding risk in AF patients.
  • These biomarkers may enhance personalized anticoagulation strategies, potentially reducing morbidity and mortality.
  • Further integration of inflammatory markers into clinical practice is warranted for improved patient management.

Keywords:
anticoagulantsatrial fibrillationbiomarkersemergency medicinegastrointestinal hemorrhage

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