431 Upper Endoscopic Findings in Anticoagulated Patients With Atrial Fibrillation Presenting With Gastrointestinal Bleeding Predicts Outcomes

Elbatta, Mohammad; Mittal, Chetan; Patsias, Iani; Garikapati, Kiran; Alirhayim, Zaid; Hassan, Syed; Qureshi, Sophia; Qureshi, Waqas

doi:10.1016/s0016-5085(13)60297-8

Cited by 2 publications

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“…Few previous studies have evaluated the impact of endoscopic findings on outcomes in patients receiving anticoagulant therapy ( 4 , 9 , 20 , 21 ). Most studies were performed in scenarios with acute gastrointestinal bleeding and in patients who had received warfarin and not DOAC therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In a cohort study of 111 hospitalized patients with acute gastrointestinal bleeding while on warfarin, patients with no identifiable cause of bleeding or minimal upper endoscopic lesions showed more favorable outcomes and lower rates of re-bleeding and emergency surgery than those with high-risk endoscopic lesions ( 4 ). In a study of 1,329 warfarin-treated AF patients with gastrointestinal bleeding, warfarin resumption was associated with a higher risk of recurrent bleeding in patients with an active PU compared with non-resumption ( 21 ). Our findings corroborate these results, showing active PU lesions (Forrest Ia–IIc) are associated with high rates of major bleeding, IS/SE, and death in DOAC users.…”

Section: Discussionmentioning

confidence: 99%

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Safety and Effectiveness of Direct Oral Anticoagulants vs. Warfarin in Patients With Atrial Fibrillation and Endoscopy-Diagnosed Peptic Ulcer

Wang

Huang

et al. 2021

Front. Cardiovasc. Med.

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Background: Patients with active peptic ulcer (PU) were excluded from direct oral anticoagulant (DOAC) trials for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the safety and effectiveness of DOACs in AF patients with active, inactive and no peptic ulcer (PU).Methods: This study accessed electronic medical records from January 1, 2009 to May 31, 2019 at a multi-center healthcare provider in Taiwan and involved 2,955 AF patients who had undergone esophagogastroduodenoscopy ≤ 1 year before anticoagulation. Subjects were classified into 3 groups: active (n = 237), inactive (n = 828) and no-PU (n = 1,890) groups. We compared the risks of major bleeding, gastrointestinal bleeding, and ischemic stroke/systemic embolism (IS/SE) between DOACs and warfarin among the 3 groups.Results: In the active PU group, there were no significant differences in the risks of major bleeding [hazard ratio (HR) = 0.65, 95% confidence interval (CI) 0.08–4.98, p = 0.676], gastrointestinal bleeding (HR = 0.65, 95% CI 0.08–4.98, p = 0.676) and IS/SE (HR = 2.58; 95% CI 0.53–12.70, p = 0.243) between DOAC and warfarin (as the reference). In the inactive PU group, there were no significant differences in the risks of major bleeding (HR = 0.36, 95% CI 0.09–1.39, p = 0.138), gastrointestinal bleeding (HR = 0.21, 95% CI 0.02–1.80, p = 0.153), and IS/SE (HR = 1.04, 95% CI 0.39–2.82, p = 0.934) between DOAC and warfarin (as the reference). In the no-PU group, DOACs were associated with lower risk of major bleeding (HR = 0.26, 95% CI 0.12–0.53, p < 0.001), gastrointestinal bleeding (HR = 0.25, 95% CI 0.01–0.59, p = 0.002), and similar risk of IS/SE (HR = 0.92, 95% CI 0.55–1.54, p = 0.757) compared to warfarin.Conclusions: DOACs were as effective as warfarin in preventing IS/SE irrespective of PU status and safer than warfarin in reducing major bleeding in the no-PU group. In patients with active or inactive PUs, DOAC and warfarin were not significantly different in their effects on major bleeding or gastrointestinal bleeding.

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