Key result
Concomitant use of NSAIDs significantly increased the risk of anticoagulant-associated gastrointestinal bleeding (OR 2.37) in patients receiving anticoagulation therapy.
Why the study?
Predictors of anticoagulation-related gastrointestinal bleeding exist, but systematic reviews and assessments of the certainty of evidence had not been published.
What are the risk factors associated with anticoagulant-related gastrointestinal bleeding?
Meta-Analysis
What are the risk factors associated with anticoagulant-related gastrointestinal bleeding?
Effect estimate: OR 2.37 (95% CI 1.61-3.50)
This meta-analysis identifies several risk factors for anticoagulant-associated gastrointestinal bleeding, such as anemia, heart failure, and specific drug co-administrations, which are not included in current risk prediction models.
BACKGROUND/AIMS: There may be many predictors of anticoagulation-related gastrointestinal bleeding (GIB), but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify all risk factors for anticoagulant-associated GIB to inform risk prediction in the management of anticoagulation- related GIB. METHODS: A systematic review and meta-analysis were conducted to search PubMed, EMBASE, Web of Science, and Cochrane Library databases (from inception through January 21, 2022) using the following search terms: anticoagulants, heparin, warfarin, dabigatran, rivaroxaban, apixaban, DOACs, gastrointestinal hemorrhage, risk factors. According to inclusion and exclusion criteria, studies of risk factors for anticoagulation-related GIB were identified. Risk factors for anticoagulant-associated GIB were used as the outcome index of this review. RESULTS: We included 34 studies in our analysis. For anticoagulant-associated GIB, moderate-certainty evidence showed a probable association with older age, kidney disease, concomitant use of aspirin, concomitant use of the antiplatelet agent, heart failure, myocardial infarction, hematochezia, renal failure, coronary artery disease, helicobacter pylori infection, social risk factors, alcohol use, smoking, anemia, history of sleep apnea, chronic obstructive pulmonary disease, international normalized ratio (INR), obesity et al. Some of these factors are not included in current GIB risk prediction models. such as anemia, co-administration of gemfibrozil, co-administration of verapamil or diltiazem, INR, heart failure, myocardial infarction, etc. CONCLUSION: The study found that anemia, co-administration of gemfibrozil, co-administration of verapamil or diltiazem, INR, heart failure, myocardial infarction et al. were associated with anticoagulation-related GIB, and these factors were not in the existing prediction models. This study informs risk prediction for anticoagulant-associated GIB, it also informs guidelines for GIB prevention and future research.
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Ma et al. (2023) conducted a meta-analysis in Anticoagulant-associated gastrointestinal hemorrhage. Concomitant use of NSAIDs vs. No concomitant use of NSAIDs was evaluated on Anticoagulant-associated gastrointestinal bleeding (OR 2.37, 95% CI 1.61-3.50). Concomitant use of NSAIDs significantly increased the risk of anticoagulant-associated gastrointestinal bleeding (OR 2.37) in patients receiving anticoagulation therapy.
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