Reducing upper digestive bleeding risk in patients treated with direct oral anticoagulants and concomitant infection with <em>Helicobacter&nbsp;pylori</em>

Abstract

Direct oral anticoagulants (DOACs) such as apixaban or dabigatran are excellent options in preventing embolic cardiovascular events. Observational studies have shown that gastrointestinal bleeding risks produced by DOACs could be lowered when correcting some host co-factors i.e. Helicobacter pylori (HP) infection. The upper digestive bleeding (UDB) rates in patients with DOAC indication and the usefulness of anti-HP therapy addition were compared. An observational retrospective study was conducted of medical records of 260 patients treated with DOACs, 130 of whom were concomitantly treated for HP infection in accordance with Maastricht V/Florence consensus. The severity of bleeding, the complexity of endoscopic treatment required to stop the bleeding, the re-bleeding rates, the surgical treatment indication and the overall mortality rates were compared between the groups. The risk of UDB was higher in HP-untreated patients in both types of DOACs used (respectively 2.08, 2.02). HP-untreated Forrest Ia/Ib/IIa and IIb DOACs patients had more severe bleedings compared with same class of HP-treated patients (P=0.

Update S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS)

“…Unlike antiplatelet therapy (platelet aggregation inhibitors), the additional influence of H. pylori on the likelihood of bleeding is generally unclear, especially in the absence of gastro-duodenal ulcers [336,337]. Nevertheless, H. pylori eradication has favourable effects on the safety of oral anticoagulant use [338]. An observational study showed lower and less complicated bleeding rates in patients where H. pylori was eradicated compared to non-eradicated patients, particularly in older patients (with previous history of peptic ulcer [339].…”

Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – Juli 2022 – AWMF-Registernummer: 021–001

“…Dennoch hat eine H. pylori-Eradikation günstige Einflüsse auf die Sicherheit des Einsatzes oraler Antikoagulanzien [337]. Eine Observationsstudie zeigte insbesondere bei älteren Patienten (und mit Historie eines peptischen Ulcus) niedrigere und weniger komplizierte Blutungsraten bei H. pylori-Eradizierten im Vergleich zu Nicht-Eradizierten [338].…”

“…Insofern müssen Patienten mit stattgehabten Ulkusblutungen und negativem H. pylori -Testergebnis besonders konsequent auf Dauer therapiert werden. Auch bei einer Komedikation mit einem DOAK kann vermutlich das Risiko für eine Rezidivblutung durch eine Eradikationstherapie gesenkt werden 620 . Studien zu P 2 Y 12 Inhibitoren und VKA liegen zu dieser Frage nicht vor (indirekte Evidenz).…”

Peri-Ulcerative Mucosal Inflammation Appearance is an Independent Risk Factor for 30-Day Rebleeding in Patients with Gastric Ulcer Bleeding: A Multicenter Retrospective Study

“…These include large ulcers, the diameter of exposed vessels, anatomical location, treatment methods, and some concomitant diseases. [5][6][7][8][9][10] Previous research has also established a variety of scoring systems in an attempt to assess the prognosis of patients more accurately. 11,12 However, the previous research results still cannot allow clinicians to perfectly predict the prognosis of patients with ulcer bleeding.…”