Acute gastrointestinal bleeding in anticoagulated patients: Prevalence and predictors of significant endoscopic lesions and change of the management

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: Acute gastrointestinal [GI] bleeding is common in anticoagulant users. Optimal management regarding the role of endoscopy is lacking. This study aimed to elucidate the prevalence of significant endoscopic lesions and predictors of significant lesions and management change with endoscopy. Materials and Methods: A retrospective cohort study of anticoagulated patients with GI bleeding who underwent endoscopy between January 2005 and December 2014 were reviewed and analyzed. Results: There were 94 patients. Male and female were equal in number with a mean age of 71.6±10.8 years. Most (81.8%) received warfarin. Upper GI bleeding was the most common site (60.9%) followed by lower GI bleeding (28.2%), mid GI bleeding (5.5%) and undetermined (2.7%). Significant GI lesions were found in 62.7%. Peptic ulcer and colonic diverticulosis were the 2 most common causes (41.8% and 28.2%, respectively). Bleeding from coagulopathy occurred in 26.4%. Significant GI lesions led to the change of management in 53.6%, mostly with endoscopic therapy. Hematochezia (odds ratio [OR] 4.90, 95% confidence interval [CI] 1.22 to 19.50, p = 0.024) and INR <4 (OR 4.07, 95% CI 1.17 to 14.27, p = 0.028) were associated with significant GI lesions, while concomitant antiplatelets was negatively associated with significant lesions (OR 0.32, 95% CI 0.12 to 0.88, p = 0.027). Hematochezia at presentation (OR 3.64, 95% CI 1.27 to 10.53, p = 0.016) and no use of antiplatelets (OR 0.28, 95% CI 0.09 to 0.89, p = 0.031) were associated with the change of management. Conclusion: Significant GI lesions were present in two-third of anticoagulated patients who had acute GI bleeding and led to the change of management in one-third. Hematochezia, INR <4 and no concomitant antiplatelets predicted significant GI lesions. Hematochezia and no concomitant antiplatelets predicted the change of management, mostly with endoscopic therapy.