Key result
DOACs show no independent 6-week mortality benefit over VKAs, with outcomes driven by comorbidities.
Why the study?
The increased risk of upper gastrointestinal bleeding related to direct oral anticoagulants compared to vitamin K antagonists remains debated.
Do DOACs alter the outcomes of upper gastrointestinal bleeding compared to VKAs in patients on oral anticoagulants?
Cohort (n=475)
Yes
Do DOACs alter the outcomes of upper gastrointestinal bleeding compared to VKAs in patients on oral anticoagulants?
Absolute Event Rate: 7.8% vs 16.1%
p-value: p=< 0.01
In patients presenting with upper gastrointestinal bleeding, the use of DOACs does not worsen outcomes compared to VKAs; prognosis is primarily driven by underlying comorbidities.
UGIB outcomes similar with DOACs versus VKAs; leaves open whether anticoagulant type independently influences prognosis beyond comorbidities.
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.
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Gouriou et al. (2021) conducted a cohort in Upper gastrointestinal bleeding (n=475). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKA) was evaluated on Mortality at 6 weeks (p=< 0.01). Although 6-week mortality was lower in DOAC users than VKA users (7.8% vs 16.1%, P<0.01), multivariate analysis showed outcomes were driven by comorbidities rather than anticoagulant type.
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