Utility of Hemoccult Testing Before Therapeutic Anticoagulation in Venous Thromboembolism. Issue 5 (May 2017)

• Record Type: Journal Article
• Authors: Urbas, Ryan; Badri, Marwan; Albert, Nicole E.; Prince, Catherine; Mayilvaganan, Barani
• Is Part Of: Southern medical journal. Volume 110:Issue 5(2017)
• Publication Date: 2017-05
• Subjects: anticoagulation -- deep venous thrombosis -- fecal occult blood -- gastrointestinal bleeding -- HAS-BLED score; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000650
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Fecal occult blood testing (FOBT) is performed routinely before starting therapeutic anticoagulation in patients despite it never being validated to predict gastrointestinal bleeding (GIB) risk. Our objective was to determine the utility in checking the guaiac FOBT test (gFOBT) before initiating therapeutic anticoagulation in patients with a new diagnosis of venous thromboembolism (VTE). Methods: This was a retrospective chart review that examined patients with a diagnosis of VTE admitted during a 2-year period in one mid-sized tertiary care center. The gFOBT was performed before initiating anticoagulation, excluding patients with overt GIB, and analysis was performed to determine GIB outcomes. In addition, demographics, laboratory data, and comorbidities were recorded at the time of admission, and an admission hypertension, abnormal renal/liver function, stroke history, GIB history or predisposition, labile international normalization ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) score was recorded to determine other factors that were predictive of new-onset GIB when starting anticoagulation. Results: Initially, 718 patients with a new diagnosis of VTE were screened for 2 years. Ultimately, 375 patients were prescribed anticoagulation therapy and 244 had documented gFOBT. Of these 375, 14 (3.73%) had a GIB episode. A positive gFOBT was present on admission in 85.7% of those who bled ( P < 0.001). The negative predictive value of gFOBT was 99.02%; however, the positive predictive value was only 30.77%. A HAS-BLED score >2 at admission significantly predicted GIB during admission as well (median 2.4 for those with GIB and 1.6 for those without GIB, P = 0.02). Conclusions: Despite its beneficial negative predictive value, gFOBT before initiating therapeutic anticoagulation is unlikely to change the management of patients without evidence of overt GIB. Abstract : Brief DescriptionGuaiac fecal occult blood testing is done routinely before initiating therapeutic anticoagulation despite that it never has been validated in this way. The authors' retrospective analysis attempted to clarify the utility of guaiac fecal occult blood testing in determining bleeding outcomes after starting patients on therapeutic anticoagulation in the setting of venous thromboembolism, as well as to establish other risk factors.