Increased rebleeding and mortality in patients with gastrointestinal bleeding treated with anticoagulant drugs compared to antiplatelet drugs

Hosni, Mohammad N.; Rahal, Mahmoud; Tamim, Hani; Daniel, Fady; Hashash, Jana; Sharara, Ala I; Soweid, Assaad; Shaib, Yasser H; Mourad, Fadi H; Wehbeh, Antonios; Rockey, Don C.; Barada, Kassem

doi:10.1097/meg.0000000000002148

Cited by 7 publications

(12 citation statements)

References 39 publications

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“…46 In our study, the mortality in patients with anticoagulant therapy (DOAC or VKA antagonists) was similar to mortality in patients with anti-platelet therapy (10.98 versus 9.77%, OR = 1.1380, 95% CI 0.5662 to 2.2874 P = 0.7166) while in a published study patients with anticoagulant treatment have a higher risk of death and rebleeding. 47 In our multivariate model, increased mortality risk was associated with increased GB score (Coefficient value 0.233), rebleeding (Coefficient value 1.629), obscure and variceal bleeding (Coefficient value 1.232 and 1.259, respectively) and use of LMWH (Coefficient value 2.587) while diagnostic and therapeutic endoscopy were inversely correlated with mortality risk (Coefficient value −2.583 and −2.763, respectively). Compared with VKA use, DOAC treatment was not a risk factor for mortality.…”

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confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic

Popa¹,

Iordache²,

Florescu³

et al. 2022

JMDH

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Introduction During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding. Patients and Methods We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017–December 2021) including Covid-19 pandemic period (March 2020–December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection. Results A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion. Conclusion Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.

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confidence: 70%

Section: Discussionmentioning

confidence: 99%

Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic

Popa¹,

Iordache²,

Florescu³

et al. 2022

JMDH

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“…Classification of GIB as upper, lower or middle GIB was done as previously described. 13 Severe GIB was defined by the presence of any of the following: systolic blood pressure <100 mm Hg, > 2 units of blood transfused, or ≥ 2 g drop in hemoglobin. Stigmata of recent hemorrhage (SRH) was defined as the presence of any of the following during endoscopy: spurting or oozing blood, visible vessel, adherent blood clot, or a pigmented raised spot.…”

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confidence: 99%

“…Data were collected prospectively directly from patients and/or from their medical record as previously described. 13 In brief, complete details about hospital management including presenting symptoms and signs, laboratory data, complete medications (including proton pump inhibitor administration, discontinuation or continuation of AT, and discharge medications), blood transfusion, and outcomes. For each medication, date of initiation, dose, and route of administration were recorded.…”

Section: Data Collectionmentioning

confidence: 99%

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Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding

Nammour¹,

Jamal²,

Hosni³

et al. 2022

Journal of Clinical Gastroenterology

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Goals and Background: We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB). Study: We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors. Results: Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P<0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P<<0.0001), the Oakland score for lower GIB (AUC=0.69, p=0.004), or the Shock Index for all (AUC=0.54, P<0.0001). Conclusion: A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.

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Overt Gastrointestinal Bleeding in Patients with Cancer: Clinical Characteristics and Outcomes

Anthony,

Najlaa,

Hashash Jana

et al. 2024

The American Journal of the Medical Sciences

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Increased rebleeding and mortality in patients with gastrointestinal bleeding treated with anticoagulant drugs compared to antiplatelet drugs

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 39 publications

Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic

Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic

Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding

Overt Gastrointestinal Bleeding in Patients with Cancer: Clinical Characteristics and Outcomes

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