Key result
Resuming NOACs after GI bleed linked to ~90% lower mortality.
Why the study?
Data on outcomes of patients with gastrointestinal bleeding while on novel oral anticoagulants are limited, particularly regarding the impact of resuming NOACs after hospitalization.
Does resumption of NOACs at discharge improve all-cause mortality in patients hospitalized with gastrointestinal bleeding while on NOACs?
Cohort (n=85)
No
Does resumption of NOACs at discharge improve all-cause mortality in patients hospitalized with gastrointestinal bleeding while on NOACs?
Odds Ratio: 0.1 (95% CI 0.01–0.56)
p-value: p=0.005
Resumption of NOAC therapy at discharge after hospitalization for gastrointestinal bleeding is associated with improved survival.
May support NOAC resumption after GI bleeding; leaves open confirmation in randomized trials.
Introduction: Restarting warfarin after hospitalization for gastrointestinal bleeding (GIB) is associated with improved mortality without a significantly increased risk of re-bleeding. However, data on outcomes of patients with GIB while on novel oral anticoagulants (NOAC) are limited. The objective of this study is to describe clinical variables that are associated with early resumption of NOACs after index hospitalization for GIB, and to evaluate whether resumption of NOACs at discharge improves all-cause mortality. Methods: We performed a retrospective analysis of consecutive patients admitted to a single-center tertiary-care academic medical center from 1/2008 to 6/2015 with GIB while on NOAC. Medications, labs, comorbidities, and source of bleeding were extracted from the EMR, and mortality data was linked to social security death indices. Comparisons between groups for categorical and continuous data were made with Fisher's exact test, 2-sample t-test, and Wilcoxon tests when appropriate. Univariate and ageadjusted multivariable logistic regression were used to determine whether resuming NOAC was associated with improved all-cause mortality. Results: 85 patients on NOACs, with a median age of 70 years (range: 24 to 93 years), were hospitalized with GIB. Seventy-seven patients (91%) underwent endoscopy and 4 patients (5%) died during hospitalization. Patients in whom NOACs were resumed at discharge were significantly younger (65.5 yrs vs 71 yrs, p = 0.02), had fewer comorbidities (Charlson comorbidity index 2.5 vs 4, p=0.005) and had lower prevalence of solid malignancy (3 pts vs 21 pts, p = 0.02). Patients in whom NOACs were held had a lower hemoglobin (7.2 vs 9.1, p = 0.006) and higher transfusion requirements (47% vs 14%, p = 0.004). The specific NOAC, location, or etiology of GIB was not different between the two groups. After discharge, 14% (12 pts) died after index hospitalization for GIB, 5% (4 pts) were admitted for re-bleeding and 1% (1 pt) had a stroke. Resumption of NOAC at discharge was associated with a significantly reduced odds of death (OR 0.10, 95% CI 0.01-0.56, p = 0.005). The association remained significant after adjusting for age (OR 0.13, 95% CI 0.006-0.72, p = 0.016). Conclusion: Resumption of NOAC therapy after hospitalization for GIB is associated with improved survival.Table 1: Patient Characteristics
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Nigam et al. (2016) conducted a cohort in Gastrointestinal bleeding while on NOAC (n=85). Resumption of NOACs at discharge vs. NOACs held at discharge was evaluated on All-cause mortality (OR 0.10, 95% CI 0.01-0.56, p=0.005). Resumption of NOAC therapy at discharge after hospitalization for gastrointestinal bleeding was associated with significantly reduced odds of death (OR 0.10; 95% CI 0.01-0.56; p=0.005).
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