Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists. Issue 6 (5th January 2021)

• Record Type: Journal Article
• Authors: Gouriou, Claire; Bouguen, Guillaume; Lahmek, Pierre; Pelaquier, Agnes; Arotcarena, Ramuntxo; Garioud, Armand; De Montigny‐Lenhardt, Stephanie; Pauwels, Arnaud; Zanditenas, David; Charpignon, Claire; Combes, Remi; Nahon, Stephane; Quentin, Vincent
• Other Names: Agnello Christophe investigator.; Alabert Frédérique investigator.; Amil Morgane investigator.; Arondel Yves investigator.; Arotcarena Ramuntcho investigator.; Arpurt Jean‐Pierre investigator.; Baconnier Karim Aziz Mathieu investigator.; Barge Sandrine investigator.; Barjonet Georges investigator.; Baudon Julien investigator.; Bauguion Lucile investigator.; Bellecoste Marie investigator.; Bellon Serge investigator.; Benezech Alban investigator.; Berete Aliou investigator.; Berger Chantal investigator.; Bertolino Jean‐Guy investigator.; Bideau Karine investigator.; Billet Gaëlle investigator.; Bocci Massimo investigator.; Borel Isabelle investigator.; Boualit Madina investigator.; Boutroux Dominique investigator.; Bramli Slim investigator.; Catala Pascale investigator.; Charpignon Claire investigator.; Chelly Jonathan investigator.; Colin Marie investigator.; Combes Rémi investigator.; Costes Laurent investigator.; Coulibaly Baya investigator.; Cuen David investigator.; D'hautefeuille Gaëlle investigator.; Davy Hortense investigator.; De Lustrac Mercedes investigator.; De Montigny‐Lenhardt Stéphanie investigator.; Delobel Jean‐Bernard investigator.; Dobrin Anca‐Stela investigator.; Ehrhard Florent investigator.; El Hajjl Weam investigator.; Elriz Khaldoun investigator.; Esch Anouk investigator.; Faroux Roger investigator.; Fron Mathilde investigator.; Garceau Cécile investigator.; Garioud Armand investigator.; Geagea Edmond investigator.; Grasset Denis investigator.; Guerbau Loïc investigator.; Haque Jessica investigator.; Harnois Florence investigator.; Heluwaert Frédéric investigator.; Heresbach Denis investigator.; Herrmann Sofia investigator.; Horaist Clémence investigator.; Kaassis Mehdi investigator.; Kerneis Jean investigator.; Koudougou Carelle investigator.; Lagin Ludovic investigator.; Laly Margot investigator.; Lam You‐Heng investigator.; Leblanc‐Boubchir Rachida investigator.; Legruyer Antonia investigator.; Lemee Delphine investigator.; Locher Christophe investigator.; Louvel Dominique investigator.; Lubret Henri investigator.; Macaigne Gilles investigator.; Mace Vincent investigator.; Maillard Emmanuel investigator.; Meszaros Magdalena investigator.; Moussaoui Mohammed Redha investigator.; Nahon Stéphane investigator.; Nobecourt Amélie investigator.; Pateu Etienne investigator.; Paupard Thierry investigator.; Pauwels Arnaud investigator.; Pelaquier Agnès investigator.; Pennec Olivier investigator.; Petiet Mathilde investigator.; Pinard Fabien investigator.; Polin Vanessa investigator.; Prieto Marc investigator.; Quartier Gilles investigator.; Quentin Vincent investigator.; Remy André‐Jean investigator.; Ripault Marie‐Pierre investigator.; Rosa Isabelle investigator.; Salvati Thierry investigator.; Schnee Matthieu investigator.; Senouci Leila investigator.; Skinazi Florence investigator.; Talbodec Nathalie investigator.; Thiebault Quentin investigator.; Touze Ivan investigator.; Trompette Marie investigator.; Tsakiris Laurent investigator.; Vandamme Hélène investigator.; Vanveuren Charlotte investigator.; Verlynde Juliette investigator.; Vickola Joseph investigator.; Vitte René‐Louis investigator.; Wartel Faustine investigator.; Zaharia Oana investigator.; Zanditenas David investigator.; Zavadil Patrick investigator.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 53:Issue 6(2021)
• Page Start: 688
• Page End: 695
• Publication Date: 2021-01-05
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.16236
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: The increased risk of upper gastrointestinal bleeding (UGIB) related to direct oral anticoagulants (DOACs) as compared to vitamin K antagonists (VKA) remains debated. Aims: To describe the epidemiology and outcomes of UGIB in patients treated with oral anticoagulants. Methods: A prospective, multicentre study in French general hospitals enrolled all consecutive patients with UGIB during one year. Patients treated with oral anticoagulants were retrieved from the cohort. Main outcomes were mortality and rebleeding during the first 6 weeks and need for non‐endoscopic treatment (surgery or interventional radiology). Results: Among the 2498 patients included, 475 (19%) had an oral anticoagulant, mostly with VKA (267 patients [56.2%]). Baseline characteristics were similar between the groups except for renal failure and cirrhosis that were more prevalent in the VKA group. Gastroscopy was normal in 73 patients (15.3%); peptic lesions were the main cause of UGIB (n = 233, 49%). Endoscopic treatment was performed in 128 patients (26.9%), leading to bleeding resolution in 74% (n = 95). Mortality rate at 6 weeks was 12.4% (59 patients), and was higher in the VKA group compared to DOACs (16.1% vs 7.8%, P < 0.01). By multivariate analysis, only the Charlson index ≥ 5 and UGIB occurrring in in‐patients were independently associated with mortality. Rebleeding (56 patients [11.8%]) and need for non‐endoscopic treatment (18 patients [3.8%]) were not associated with the type of anticoagulant. Conclusion: DOACs do not alter outcomes of UGIB as compared to VKA. Comorbidities and associated treatment are the most important factors worsening the prognosis of UGIB.