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June 1, 2014

Management of gastrointestinal bleeding in patients anticoagulated with dabigatran compared with warfarin: a retrospective, comparative case review.

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Key result

Patients with gastrointestinal bleeding from dabigatran received significantly fewer packed red blood cell transfusions compared to those on warfarin (0.69 vs. 1.92 units, p=0.024), with similar clinical outcomes.

Why the study?

Does dabigatran compared with warfarin reduce blood transfusion requirements and improve clinical outcomes in patients hospitalized for gastrointestinal bleeding?

Population

39 patients hospitalized for gastrointestinal bleeding who were taking either dabigatran or warfarin for…

Comparison

Dabigatran for non-valvular atrial fibrillation vs Warfarin with therapeutic international…

Design

Cohort

Follow-up

Hospitalization period (mean length of stay 5.6 to 5.9 days)

Authors

WMWuttiporn ManatsathitCreighton UniversityHAHussein Al-HamidHonorHealthPLPornchai LeelasinjaroenAugusta University

Discussion

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Member takes

Overview

Dabigatran-associated GI bleeding linked to fewer transfusions; leaves open whether severity differs or reflects confounding in this cohort.

Study Design

Type

Observational (n=39)

Multicenter

No

Structured PICO

Does dabigatran compared with warfarin reduce blood transfusion requirements and improve clinical outcomes in patients hospitalized for gastrointestinal bleeding?

P
Population
39 elderly patients (mean age 76.6 years, 53.8% female) hospitalized for gastrointestinal bleeding while taking dabigatran or warfarin for non-valvular atrial fibrillation.
E
Exposure
Dabigatran for non-valvular atrial fibrillation (patients presenting with GI bleeding)
C
Comparator
Warfarin with therapeutic international normalized ratio (INR 2-3) for non-valvular atrial fibrillation (patients presenting with GI bleeding)
O
Outcome
Number of transfused packed red blood cells (PRBCs), acute kidney injury, clinical outcomes (hypotension, tachycardia), length of stay, and death during hospitalizationhard clinical

Main Result

Absolute Event Rate: 0.69% vs 1.92%

p-value: p=0.024

In patients hospitalized for GI bleeding, those anticoagulated with dabigatran required significantly fewer blood transfusions compared to those on warfarin, with similar overall clinical outcomes and length of stay.

Limitations

  • Small sample size
  • Retrospective design unable to control for clinical decision-making
  • No protocol for in vitro diagnostics for GI bleeding on novel anticoagulants
  • Higher prevalence of concurrent aspirin use in the dabigatran group
  • Small case series
  • Unable to control for clinical decision-making in the management of GI bleeding or original choice of anticoagulation
  • No protocol in place for in vitro diagnostics for GI bleeding on novel anticoagulants

Cite This Study

Manatsathit et al. (2014) conducted an observational in Gastrointestinal bleeding (n=39). Dabigatran vs. Warfarin was evaluated on Number of transfused packed red blood cells (PRBCs) (p=0.024). Patients with gastrointestinal bleeding from dabigatran received significantly fewer packed red blood cell transfusions compared to those on warfarin (0.69 vs. 1.92 units, p=0.024), with similar clinical outcomes.

synapsesocial.com/papers/6a81ced552af26425e4d5ea1https://doi.org/10.3978/j.issn.2223-3652.2014.03.07
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effective elimination of dabigatran by haemodialysis2013 · 206 citations
  2. 2Reversal of dabigatran-induced bleeding with a prothrombin complex concentrate and fresh frozen plasma2012 · 68 citations
  3. 3Fatal gastrointestinal hemorrhage after a single dose of dabigatran2012 · 40 citations
  4. 4Impact of dabigatran on a large panel of routine or specific coagulation assays2012 · 324 citations
  5. 5Dabigatran versus Warfarin in Patients with Atrial Fibrillation2009 · 11,280 citations