Key result
Patients taking new oral anticoagulants who experienced acute gastrointestinal bleeding had a significantly lower risk of rebleeding compared to those on vitamin K antagonists (adjusted OR 0.42).
Why the study?
The etiology, clinical course, and risk of gastrointestinal bleeding associated with new oral anticoagulants compared to vitamin K antagonists remain unclear.
Do NOACs improve the severity and clinical outcomes of acute gastrointestinal bleeding compared to VKAs in patients requiring anticoagulation?
Cohort (n=381)
Yes
Do NOACs improve the severity and clinical outcomes of acute gastrointestinal bleeding compared to VKAs in patients requiring anticoagulation?
In patients experiencing acute gastrointestinal bleeding, those taking NOACs have less severe bleeding and better clinical outcomes compared to those taking vitamin K antagonists.
NOAC-associated GI bleeding linked to lower rebleeding risk than VKA; hypothesis-generating and should not yet change practice.
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA.
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Choe et al. (2021) conducted a cohort in Acute gastrointestinal bleeding in patients on anticoagulants (n=381). New oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKA) was evaluated on Rebleeding (adjusted OR 0.42, 95% CI 0.22-0.79, p=0.007). Patients taking new oral anticoagulants who experienced acute gastrointestinal bleeding had a significantly lower risk of rebleeding compared to those on vitamin K antagonists (adjusted OR 0.42).
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