New oral anticoagulants and upper gastrointestinal bleeding

Česká verzia

Authors: Mihalkanin Ľ. ¹; Stančák B. ²
Authors place of work: Gastroenterologická ambulancia, Gastro LM s. r. o., Prešov ¹; Východoslovenský ústav srdcových a cievnych chorôb, a. s., Košice ²
Published in the journal: Gastroent Hepatol 2019; 73(4): 326-332
Category: Klinická a experimentální gastroenterologie: původní práce
doi: https://doi.org/10.14735/amgh2019326

Summary

Background: Novel oral non-vitamin K antagonist anticoagulants (NOAC) are more effective and safer medications than warfarin to prevent and treat venous thromboembolism and to prevent stroke in patients with atrial fibrillation. Although NOACs are associated with an overall decrease in hemorrhagic complications, findings regarding the incidence of gastrointestinal tract (GIT) bleeding are contradictory. This prospective single-center study aimed to compare the occurrence of upper GIT bleeding during NOAC and warfarin treatment, and to identify risk factors for bleeding.

Methods: A cohort of 80 patients with a mean age of 74.8 years was divided into four equivalent groups. After exclusion of patients with preexisting pathological lesions in the upper GIT mucosa on esophageal-gastroduodenoscopic (EGD) examination at entry, anticoagulation therapy with dabigatran, rivaroxaban, apixaban, or warfarin was initiated. All patients were followed up for 3 months after treatment initiation, with a focus on anamnestic and endoscopic signs of bleeding. In addition, risk factors for bleeding were evaluated.

Results: When anticoagulant therapy was initiated with an intact upper gastrointestinal mucosa, serious or clinically significant GIT bleeding was not detected in any patients treated with warfarin or NOACs. No patients required hospitalization or an additional medical examination. The incidence of bleeding (anamnestic or endoscopically detected) did not differ among the groups (χ² = 2.8458; p = 0.41608) within 3 months of treatment initiation. The incidence of endoscopically detected, clinically asymptomatic bleeding was moderate in patients treated with warfarin (4/20, 20%), dabigatran (4/20, 20%), rivaroxaban (2/20, 10%), and apixaban (1/20, 5%). The presence of Helicobacter pylori (HP) was a risk factor for upper GIT bleeding (p < 0.05), while the use of proton pump inhibitors (PPIs) was a protective factor (p = 0.206; Spearman’s correlation coefficient = 0.205). No patients experienced continuous bleeding associated with upper GIT biopsy.

Conclusion: In patients with an increased risk of upper GIT bleeding, we believe it is beneficial to perform EGD examination prior to initiating any anticoagulation treatment. Detection and eradication of HP and preventive administration of PPIs are advised in these patients. Biopsy is safe in patients taking NOACs or warfarin.

Doručené/Submitted: 5. 6. 2019

Prijaté/Accepted: 3. 7. 2019

MUDr. Ľubomír Mihalkanin

Gastroenterologická ambulancia

Gastro LM s. r. o.

Jurkovičová 18

080 01 Prešov

mihalkanin@gmail.com

Keywords:

warfarin – NOAC – gastrointestinal bleeding – esophagogastroduodenoscopy – Helicobacter pylori – PPI – endoscopic biopsy

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