Risk Factors for Rebleeding and Thromboembolism after Hospitalization for Gastrointestinal Bleeding in Patients on Novel Oral Anticoagulants

2017 ◽  
Vol 152 (5) ◽  
pp. S112
Author(s):  
Neil Sengupta ◽  
Blake A. Jones
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants

Abstract 15237: Predictors of Intracranial and Gastrointestinal Bleeding in Cirrhosis With Use of Direct Oral Anticoagulants: A Large Population Based Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad U Butt ◽  
Aun R Shah ◽  
Osama Hamid ◽  
Sara Ghoneim ◽  
Maham Malik
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Large Population ◽  
Bleeding Risk ◽  
Population Based ◽  
Snomed Ct ◽  
Risk Of Bleeding ◽  
Cirrhotic Patients

Introduction: Use of Direct Oral Anticoagulants (DOACs) in patients with cirrhosis remains controversial, as the studies demonstrating safety of DOACs excluded these patients. Hypothesis: To determine the predictors of Intracranial and Gastrointestinal bleeding in cirrhosis with use of DOACs. Methods: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified adults with liver cirrhosis, intracranial and gastrointestinal bleeding. Risk factors known to be associated with bleeding such as alcohol abuse, NSAIDs, CKD and advanced age were collected. Bleeding risk with DOAC use was compared with coumadin. Univariable and multivariable logistic regression analyses were performed to investigate strongest predictors Results: Out of 61.4 million active adult patients in the database, 468,580 patients (0.61%) had documented cirrhosis. 9.14 % and 3.14 % of the cirrhotic patients were on DOACs and coumadin, respectively. In cirrhotic patients, there was higher composite risk of ICH or GIB if they were on DOACs (35.47% vs 21.24 % OR 2.04 [2.01-2.07]), used NSAIDs (31.15% vs 23.63% OR 1.46 [1.44-1.48]), had CKD (32.61% vs 25.04 %, OR 1.45 [1.42-1.47]), or abused alcohol (36.22% vs 23.57%, OR 1.84 [1.81- 1.87]). Risk of bleeding was higher with DOACs as compared to coumadin (35.47% vs 22.81%: p< 0.001). In Multivariable model CKD modified composite bleeding risk of ICH or GIB after adjustment for other risk factors. A cirrhotic patient on DOAC had higher risk of bleeding with CKD (OR 2.29 [(2.22-2.37)]) than without CKD (OR 1.66 [(1.63-1.69)]). This interaction was found to be statistically significant. Similar trend was noticed with use of coumadin. Conclusions: Major bleeding risk in cirrhosis was significantly higher with use of DOACs as compared to warfarin. This risk was highest in patients with CKD.

scholarly journals PTU-046 Mind Over Matter? Gastrointestinal Bleeding Due To The Use Of Novel Oral Anticoagulants In Stroke Prevention

Gut ◽  
2014 ◽  
Vol 63 (Suppl 1) ◽  
pp. A58.2-A59 ◽  
Author(s):  
S Beg ◽  
J Patel ◽  
M Bhuva ◽  
D Collas ◽  
B Macfarlane
Keyword(s):  
Gastrointestinal Bleeding ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants

scholarly journals Management of risk factors for gastrointestinal bleeding in patients receiving anticoagulant therapy

2021 ◽  
Vol 26 (8) ◽  
pp. 4635
Author(s):  
N. V. Bakulina ◽  
S. V. Tikhonov ◽  
N. B. Lishchuk ◽  
A. B. Karaya
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Gastrointestinal Diseases ◽  
Thromboembolic Events ◽  
Antiinflammatory Drugs ◽  
Patient Profile ◽  
Increased Risk

Direct oral anticoagulants (DOACs) are used to prevent and treat thrombosis and thromboembolic events in patients with various diseases. Despite its high efficacy and safety, DOAC therapy is accompanied by increased risk of hemorrhage, including gastrointestinal bleeding. Bleeding risk depends on individual patient profile and their risk factors. An increased risk of bleeding is associated with manifesting effect of DOACs on existing mucosal defects, active Helicobacter pylori infection. To reduce the risk of gastrointestinal bleeding in clinical practice, changing of following modifiable risk factors is required: H. pylori eradication; dose-adjusted DOAC therapy; prophylactic proton pump inhibitors (PPIs) administration to patients with HAS-BLED score ≥3, receiving dual or triple antithrombotic therapy, taking DOACs in combination with non-steroidal antiinflammatory drugs, to those with upper gastrointestinal diseases. In addition to PPIs, patients may be prescribed with rebamipide, bismuth tripotassium dicitrate, ursodeoxycholic acid. DOAC rivaroxaban (Xarelto®) has pharmacokinetic and pharmacodynamic advantages, a convenient single dosing regimen and a favorable safety profile, which provides effective protection against thrombosis and thromboembolic events in combination with low risk of gastrointestinal bleeding.

scholarly journals Gastrointestinal Bleeding in Antithrombotic Therapy in Patients with Coronary Heart Disease: Risk Factors, Pathogenesis and Treatment

2020 ◽  
Vol 30 (3) ◽  
pp. 14-23
Author(s):  
N. S. Lapina ◽  
A. A. Alekseeva ◽  
A. D. Vershinina ◽  
N. S. Khruleva ◽  
F. N. Muradova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Antithrombotic Therapy ◽  
Disease Risk ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Strategies ◽  
Concomitant Treatment

Aim. Description of risk factors, pathogenesis and treatment strategies of gastrointestinal bleeding (GIB) in the course of antithrombotic therapy in patients with coronary heart disease (CHD).Key points. Risk factors of GIB during antithrombotic therapy in CHD patients include: GIB, gastric and/or duodenal ulcer in the history, reflux esophagitis, presence of H. pylori, inflammatory bowel disease, diverticula, haemorrhoids, angiodysplasia, gastrointestinal neoplasia, age above 65 years, concomitant treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glomerular filtration rate <50 mL/min, high doses of direct oral anticoagulants (DOACs) ≥3 in HAS-BLED score. Pathogenesis of GIB in the course of antithrombotic therapy is associated with systemic hypocoagulation and local damaging effects of these drugs. Strategies of GIB treatment during DOAC therapy in patients with CHD are determined by severity of bleeding and threat to life. Aside to standard conservative measures, endoscopic or surgical haemostasis requires usage of antidotes to suppress effects of DOACs and other specific drugs in severe cases.Conclusion. GIB associated with antithrombotic therapy in CHD patients poses a serious medical problem of growing importance with wider application of anticoagulant drugs. Antithrombotic therapy requires accurate decision making, risk assessment, careful monitoring of the patient’s condition and timely diagnosis of gastrointestinal disorders following good rationale in GIB prevention.

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