Thirty-day mortality in atrial fibrillation patients with gastrointestinal bleeding in the emergency department: differences between direct oral anticoagulant and warfarin users

Turcato, Gianni; Bonora, Antonio; Zorzi, Elisabetta; Zaboli, Arian; Zannoni, M; Ricci, Giorgio; Pfeifer, Norbert; Antonio, Miguel; Tenci, Andrea

doi:10.1007/s11739-019-02229-7

Cited by 9 publications

(5 citation statements)

References 34 publications

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“… 43 Some studies or meta-analyses which include all bleeding reported a case fatality of 6.1% for DOAC and 10.4% for VKA, 31 9.8% for DOAC versus 15.2% for VKA, 38 7.57% for DOAC and 11.04% for warfarin in a meta-analysis of 13 randomized trials 44 (with the difference mainly due to a decrease in intracranial bleeding for DOAC) and 8.3% for VKA and 9.7% for DOAC in another meta-analysis of 27 studies and nearly 10,000 patients. 34 Several studies including only GIB showed that 7.1% of DOAC patients and 8.7% of warfarin patients died from 284 patients, 32 16.1% at 6 weeks in VKA group versus 7.8% in DOAC group (P < 0.01, 475 patients with UGIB) but more patients in VKA group had cirrhosis (13.1 versus 4.3, P = 0.001) and kidney failure (38.6 versus 19.2%, P < 0.0001). 30 In a study including 61 patients treated with DOAC and 123 treated with warfarin no difference of mortality was noted, 33 while in a large, national seven-year study of over 40,000GIB patients, 5774 (14.1%) patients received an oral anticoagulant therapy; unadjusted in-hospital mortality was 7.5% for DOAC (7.2% for dabigatran, 6.4% for rivaroxaban, 10.1% for apixaban) and 6.5% for warfarin; and after adjustment for demographic and clinical characteristics, no significant difference was seen between DOAC and VKA users (adjusted OR 0.97), but only 38.6% had UGIB in DOAC group and 50.4% in VKA group.…”

Section: Discussionmentioning

confidence: 99%

“…21,22,27,28 A meta-analysis of 8 cohort studies which included 1442 patients with gastrointestinal hemorrhage among the 10,713 patients using rivaroxaban and 106,626 patients using dabigatran found a higher risk for dabigatran compared with VKA and similar risk for rivaroxaban. 29 Several studies have estimated specific mortality in gastrointestinal bleeding associated with the type of antithrombotic therapy, [30][31][32][33][34][35][36] with a higher mortality for VKA as compared with DOAC in some studies 30,31 and similar mortality in others; 32,33,36 only some studies have evaluated the mortality risk for patients with gastrointestinal bleeding on anticoagulant versus antiplatelet therapy. There is heterogeneity of the studies related to monotherapy, dual or triple therapy with different doses, and because of many confounding factors (age, indication for therapy, gastro protective or gastric harmful drugs use, comorbidities or H. pylori infection).…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…In another study, mortality was observed in 8.7% of 172 patients who presented with GIB treated with warfarin during 1-month follow-up. [13] The high mortality rate in our study was thought to be related to the evaluation of a specific group undergoing treatment with GIB, and the fact that the selected group included high-risk patients with higher bleeding findings that would require endoscopic treatment.…”

Section: Resultsmentioning

confidence: 99%

An Easy Nomogram to Predict 30-Day Mortality in Warfarin Overdose Patients Undergoing Endoscopy for Gastrointestinal Bleeding

Tolunay¹

2021

Laparosc Endosc Surg Sci

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Introduction: Gastrointestinal bleeding (GIB) is a crucial medical issue in patients receiving oral anticoagulant therapy. Thus, the management of these patients is important in daily clinical practice. In this study, first, we sought to show the predictors of mortality and, second, provide a nomogram for clinicians to evaluate the risk of mortality in patients undergoing endoscopic therapy with warfarin overdose. Materials and Methods:Patients who underwent endoscopic treatment with warfarin overdose and GIB between February 15, 2019, and March 20, 2021, were retrospectively evaluated. Clinical, demographic, and laboratory parameters of patients were recorded. The primary outcome was 30-day all-cause mortality after the procedure.Results: A total of 359 patients admitted with warfarin overdose and GIB who underwent endoscopic treatment were included in the study. All-cause death was observed in 50 (14%) patients in the 30-day period after the procedure. According to univariate and multivariate logistic regression analysis, age (OR=1.019; 95% CI=1.000-1.039; p=0.008), hypertension (OR=1.909; 95% CI=1.051-3.468; p=0.004), alcohol history (OR=1.618; 95% Cl=1.196-2.954; p=0.018), and albumin value (OR=0.318; 95% Cl=0.214-0.471; p=0.001) were determined as independent predictors for 30-day all-cause mortality. The areas under the curves of the nomogram were 0.73 (95% CI: 0.70-0.76) may have clinical usefulness. Conclusion:This study provides a nomogram containing age, hypertension, alcohol, and albumin that can be conveniently used to predict individual mortality in warfarin overdose patients undergoing endoscopy for GIB.

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“…La FA es la arritmia cardiaca más frecuente en el mundo (22)(23)(24). La anticoagulación es menester en el abordaje holístico de estos pacientes, lo cual, acompañado de otros factores de riesgo, puede incrementar el riesgo de SGI, representando un reto sopesar que anticoagulante utilizar y el riesgo de sangrado vs. tromboembolismo (22,23).…”

Section: Riesgo De Sangrado Gastrointestinal Con El Uso De Anticoagul...unclassified

Riesgo de sangrado gastrointestinal por uso de anticoagulantes directos orales: ¿cuál es más seguro?

Lozada Martinez,

Solano Díaz,

Barbosa Pérez

et al. 2022

rev cuarzo

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Los anticoagulantes directos orales fueron agentes que cambiaron radicalmente la estrategia de anticoagulación, sobre todo en el manejo del riesgo cardiovascular e incidencia de eventos tromboembólicos. No obstante, de acuerdo a su mecanismo de acción, era imperativo el riesgo de sangrado como evento adverso. El sangrado gastrointestinal es una de las localizaciones más frecuentes asociadas a estos eventos, el cual, de acuerdo al estado del paciente, puede comprometer el estado hemodinámico, endocrino y funcional del paciente. Por lo tanto, esta es una condición que acarrea elevados costos en salud, afecta la calidad de vida del paciente y es un potencial desencadenante de morbilidad y mortalidad. Distintos factores de riesgo pueden contribuir al incremento del riesgo de sangrado, y es un reto sopesar la relación beneficio-riesgo y costo-efectividad. Existen brechas respecto a los perfiles de seguridad y eficacia en la actualidad, puesto que estudios recientes han encontrado variabilidad del rendimiento de estos medicamentos, considerando algunos análisis por subgrupos. Considerando lo anterior, el objetivo de esta revisión consiste en sintetizar evidencia sobre los perfiles de eficacia y seguridad de los anticoagulantes directos orales, en pacientes con antecedente o no de sangrado gastrointestinal, y ciertos subgrupos, quienes requieren de manera obligatoria esta terapia. Se llevó a cabo una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Embase, EBSCO y MEDLINE. Revisiones recientes sobre este tema, han descrito varios factores que pueden influir sobre el riesgo de sangrado gastrointestinal con el uso de anticoagulantes directos orales, algunos modificables, otros no modificables, los cuales deben tenerse en cuenta en la práctica clínica, como lo son: edad avanzada (> 75 años), elevadas dosis de anticoagulación, uso concomitante de esteroides, antiagregantes plaquetarios y antiinflamatorios no esteroideos, antecedente de sangrado gastrointestinal, etnia, y disminución de la función renal, entre otros. Y a pesar que la evidencia es heterogénea, y aunque parece ser que los anticoagulantes directos orales demuestran ser superiores a la Warfarina, existen algunos que revelan un perfil de seguridad y eficacia mejor que otros. Parece ser que Apixaban en dosis de 5 mg dos veces al día es el agente farmacológico de este grupo más seguro, mientras que Rivaroxaban es el agente que exhibe mayor riesgo de sangrado gastrointestinal. Estos resultados, son similares tanto de manera general, como en pacientes con fibrilación auricular, donde es más difícil sopesar la relación beneficio-riesgo.

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Thirty-day mortality in atrial fibrillation patients with gastrointestinal bleeding in the emergency department: differences between direct oral anticoagulant and warfarin users

Cited by 9 publications

References 34 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

An Easy Nomogram to Predict 30-Day Mortality in Warfarin Overdose Patients Undergoing Endoscopy for Gastrointestinal Bleeding

Riesgo de sangrado gastrointestinal por uso de anticoagulantes directos orales: ¿cuál es más seguro?

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