Year 2022 / Volume 114 / Number 10
Original
Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists

599-604

DOI: 10.17235/reed.2022.8388/2021

Luis G. Alcalá-González, César Jiménez, Vicente Cortina, Alba Jiménez, María Cerdá, Erik Johansson, Pável Olivera, Amparo Santamaría, Carmen Alonso-Cotoner,

Abstract
Background: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. AIMS: To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. Methods: Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. Results: A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). Conclusions: Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.
Share Button
New comment
Comments

14/04/2023 20:05:58
I URGENTLY NEED AN EFFECTIVE POWERFUL STRONG LOVE SPELL CASTER HELP ME BRING BACK MY EX LOVER URGENTLY 2023 WHATSAPP +1(419)359 4367 OR UNSURPASSED.SOLUTION@GMAIL.COM

I was having issues in my marriage because my husband wants a divorce but I was able to get him to cancel the divorce with the help of a spiritual man called PRIEST OSAS and now we are living in peace. If you are facing any kind of problem in life and want a lasting solution, PRIEST OSAS is the right man for the job. I'm a living testimony of his great power. He also prepares herbs for any kind of sickness you know about, he works wonders and miracles, I thank my stars I reached out to him for help

WhatsApp +1(419)359 4367
EMAIL: Unsurpassed.solution@gmail.com


04/11/2022 7:13:39
LOVE SPELL CASTER (PRIEST LEO) THAT HELPED ME BRING BACK MY DIVORCED HUSBAND CONTACT HIM NOW FOR ANY KIND OF HELP AT +1(661) 525 4146

With so much in my heart, I am here to express myself about how PRIEST LEO saved my marriage from divorce. My husband and I were having some misunderstandings and it was tearing our marriage apart to the extent my husband was seeking a divorce. So I have no option other than to go to the internet to seek a solution to my problem. It was there I came across PRIEST LEO details and about how he has helped a lot of people by restoring their relationships. I contacted PRIEST LEO and in less than 48 hours my husband canceled the divorce papers. Now I and my husband live together in peace and harmony all thanks to PRIEST LEO for saving my marriage from breaking up. PRIEST LEO contact information or call his phone number or WhatsApp: +1(661) 525 4146 Email. Astrosolutionrealm@yahoo.com his website is http://astrosolutionrealm.website2.me/


12/10/2022 6:39:28
Good data from real life cohort


References
1. Sarvepalli S, Garg SK, Singh R, et al. Incidence, Admission Rates and Economic Burden of Adult Emergency Visits for Gastritis and Duodenitis: Data from the National Emergency Department Sample, 2006 and 2012. Gastroenterology. 2017 Apr;152(5):S477.
2. Abraham NS, Castillo DL. Novel anticoagulants: bleeding risk and management strategies. Curr Opin Gastroenterol. 2013;29(6):676-83.
3. Holster IL, Valkhoff VE, Kuipers EJ, el al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology. 2013;145(1):105-112.e15.
4. Steinberg BA, Simon DN, Thomas L, et al. Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF II]). Am J Cardiol. 2017;119(10):1590-1595.6.
5. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-62.
6. Deutsch D, Romegoux P, Boustière C, et al. Clinical and endoscopic features of severe acute gastrointestinal bleeding in elderly patients treated with direct oral anticoagulants: a multicentre study. Therap Adv Gastroenterol. 2019;12:1756284819851677.
7. Brodie MM, Newman JC, Smith T, et al. Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants. Am J Med. 2018;131(5):573.e9-573.e15.
8. Pannach S, Goetze J, Marten S, et al. Management and outcome of gastrointestinal bleeding in patients taking oral anticoagulants or antiplatelet drugs. J Gastroenterol. 2017;52(12):1211-1220.
9. Butt JH, Li A, Xian Y, et al. Direct oral anticoagulant- versus vitamin K antagonist-related gastrointestinal bleeding: Insights from a nationwide cohort. Am Heart J. 2019;216:117-124.
10. Albrecht H, Maass LS, Hagel AF, Neurath MF, Konturek PC, Raithel M. Anticoagulant-related gastrointestinal bleeding: a real-life data analysis on bleeding profiles, frequency and etiology of patients receiving direct oral anticoagulants versus vitamin K antagonists. J Physiol Pharmacol. 2019 Dec;70(6). doi: 10.26402/jpp.2019.6.11. Epub 2020 Mar 20. PMID: 32203937.
11. Gouriou C, Bouguen G, Lahmek P, Pelaquier A, Arotcarena R, Garioud A, De Montigny-Lenhardt S, Pauwels A, Zanditenas D, Charpignon C, Combes R, Nahon S, Quentin V. Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists. Aliment Pharmacol Ther. 2021 Mar;53(6):688-695. doi: 10.1111/apt.16236. Epub 2021 Jan 5. PMID: 33400827.
12. Anguita Sánchez M, Bertomeu Martínez V, Ruiz Ortiz M, et al. Direct oral anticoagulants versus vitamin K antagonists in real-world patients with nonvalvular atrial fibrillation. The FANTASIIA study. Rev Esp Cardiol (Engl Ed). 2020;73(1):14-20.
13. Lanas A, García-Rodríguez LA, Polo-Tomás M, et al. The changing face of hospitalisation due to gastrointestinal bleeding and perforation. Aliment Pharmacol Ther. 2011;33(5):585-591.
14. Seiffge DJ, Paciaroni M, Wilson D, et al. Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019;85(6):823-834.
15. Rubin TA, Murdoch M, Nelson DB. Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc. 2003;58(3):369-73.
16. Turpin M, Gregory P. Direct Oral Anticoagulant Use and Risk of Diverticular Hemorrhage: A Systematic Review of the Literature. Can J Gastroenterol Hepatol. 2019;2019:9851307.
17. Kim KO, Kozarek R, Gluck M, et al. Changes in Lower Gastrointestinal Bleeding Presentation, Management, and Outcomes Over a 10-Year Span. J Clin Gastroenterol. 2019;53(10):e463-e467.
18. Neu B, Moessmer G, Bajbouj M, et al. Risk factors for bleeding from gastrointestinal angiodysplasia: a case-control study in patients with bleeding and non-bleeding angiodysplasia. Z Gastroenterol. 2020;58(3):234-240.
19. Benamouzig R, Guenoun M, Deutsch D, et al. Review Article: Gastrointestinal Bleeding Risk with Direct Oral Anticoagulants. Cardiovasc Drugs Ther. 2021 jun 18; Online ahead of print.
20. Brodie MM, Newman JC, Smith T, et al. Severity of gastrointestinal bleeding in patients treated with direct-acting oral anticoagulants. Am J Med. 2018;131(5):573.e9-573.e15.
21. Choe AR, Monn Moon CM, Tae CH, et al. Characteristics, location, and clinical outcomes of gastrointestinal bleeding in patients taking new oral anticoagulants compared to vitamin K antagonist. J Clin Med. 2021;10(12):2693
Related articles

Letter

Blue rubber bleb nevus syndrome

DOI: 10.17235/reed.2023.9913/2023

Digestive Diseases Image

Germ cell tumor with duodenal involvement: a rare case of gastrointestinal bleeding

DOI: 10.17235/reed.2022.9327/2022

Letter

A rare cause of obscure gastrointestinal bleeding

DOI: 10.17235/reed.2022.9156/2022

Letter

Weil syndrome coincident with upper gastrointestinal bleeding

DOI: 10.17235/reed.2022.9086/2022

Letter

A full hemostatic repertoire in a complex cirrhotic patient

DOI: 10.17235/reed.2022.9039/2022

Letter

Hemostasis of a bleeding inverted colonic diverticulum

DOI: 10.17235/reed.2022.9019/2022

Letter

Primary intestinal melanoma?

DOI: 10.17235/reed.2022.8944/2022

Letter

A rare cause of a bulging mass in the mid esophagus

DOI: 10.17235/reed.2022.8834/2022

Digestive Diseases Image

Ileal neuroendocrine tumor as an uncommon cause of obscure gastrointestinal bleeding

DOI: 10.17235/reed.2022.8641/2022

Digestive Diseases Image

Bezoar: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2021.8311/2021

Letter

COVID-19 and aorto-enteric fistula

DOI: 10.17235/reed.2021.8272/2021

Digestive Diseases Image

Ink stained gastric lesions: a rare cause of gastrointestinal bleeding

DOI: 10.17235/reed.2021.8141/2021

Digestive Diseases Image

Gastric plasmacytoma: a rare cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2021.7816/2021

Case Report

Apixaban-induced liver injury

DOI: 10.17235/reed.2018.5877/2018

Letter

Symptomatic exfoliative esophagitis induced by dabigatran

DOI: 10.17235/reed.2018.5747/2018

Letter to the Editor

Severe obscure gastrointestinal bleeding successfully treated with idarucizumab

DOI: 10.17235/reed.2018.5298/2017

Letter to the Editor

Gangliocytic paraganglioma: an unusual cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2017.4808/2016

Letter to the Editor

Gastric neuroendocrine tumor presenting with gastrointestinal bleeding

DOI: 10.17235/reed.2015.3998/2015

Case Report

Downhill varices: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2015.3697/2015

Citation tools
Alcalá-González L, Jiménez C, Cortina V, Jiménez A, Cerdá M, Johansson E, et all. Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists. 8388/2021


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 958 visits.
This article has been downloaded 129 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 12/10/2021

Accepted: 27/01/2022

Online First: 28/01/2022

Published: 07/10/2022

Article revision time: 104 days

Article Online First time: 108 days

Article editing time: 360 days


Share
This article has been rated by 3 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology