TY - JOUR
T1 - Recurrent bleeding and thrombotic events after resumption of oral anticoagulants following gastrointestinal bleeding: Communication from the ISTH SSC Subcommittee on Control of Anticoagulation
AU - Candeloro, Matteo
AU - van Es, Nick
AU - Cantor, Nathan
AU - Schulman, Sam
AU - Carrier, Marc
AU - Ageno, Walter
AU - Aibar, Jesus
AU - Donadini, Marco Paolo
AU - Bavalia, Roisin
AU - Arsenault, Marie-Pier
AU - Coppens, Michiel
AU - Ferrante, Noemi
AU - D’Addezio, Andrea
AU - Sormani, Stefano
AU - Porreca, Ettore
AU - di Nisio, Marcello
N1 - Funding Information: This project was supported by a grant from the International Society on Thrombosis and Haemostasis. Publisher Copyright: © 2021 International Society on Thrombosis and Haemostasis
PY - 2021/10
Y1 - 2021/10
N2 - Background: Gastrointestinal bleeding frequently complicates anticoagulant therapy causing treatment discontinuation. Data to guide the decision regarding whether and when to resume anticoagulation based on the risks of thromboembolism and recurrent bleeding are scarce. Objectives: We aimed to retrospectively evaluate the incidence of these events after anticoagulant-related gastrointestinal bleeding and assess their relationship with timing of anticoagulation resumption. Methods: Patients hospitalized because of gastrointestinal bleeding during oral anticoagulation for any indication were eligible. All patients were followed up to 2 years after the index bleeding for recurrent major or clinically relevant non-major bleeding, venous or arterial thromboembolism, and mortality. Results: We included 948 patients hospitalized for gastrointestinal bleeding occurring during treatment with vitamin K antagonists (n = 531) or direct oral anticoagulants (n = 417). In time-dependent analysis, anticoagulant treatment was associated with a higher risk of recurrent clinically relevant bleeding (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.08–2.22), but lower risk of thromboembolism (HR 0.34; 95% CI 0.21–0.55), and death (HR 0.50; 95% CI 0.36–0.68). Previous bleeding, index major bleeding, and lower glomerular filtration rate were associated with a higher risk of recurrent bleeding. The incidence of recurrent bleeding increased after anticoagulation restart independently of timing of resumption. Conclusions: Anticoagulant treatment after gastrointestinal bleeding is associated with a lower risk of thromboembolism and death, but higher risk of recurrent bleeding. The latter seemed to be influenced by patient characteristics and less impacted by time of anticoagulation resumption.
AB - Background: Gastrointestinal bleeding frequently complicates anticoagulant therapy causing treatment discontinuation. Data to guide the decision regarding whether and when to resume anticoagulation based on the risks of thromboembolism and recurrent bleeding are scarce. Objectives: We aimed to retrospectively evaluate the incidence of these events after anticoagulant-related gastrointestinal bleeding and assess their relationship with timing of anticoagulation resumption. Methods: Patients hospitalized because of gastrointestinal bleeding during oral anticoagulation for any indication were eligible. All patients were followed up to 2 years after the index bleeding for recurrent major or clinically relevant non-major bleeding, venous or arterial thromboembolism, and mortality. Results: We included 948 patients hospitalized for gastrointestinal bleeding occurring during treatment with vitamin K antagonists (n = 531) or direct oral anticoagulants (n = 417). In time-dependent analysis, anticoagulant treatment was associated with a higher risk of recurrent clinically relevant bleeding (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.08–2.22), but lower risk of thromboembolism (HR 0.34; 95% CI 0.21–0.55), and death (HR 0.50; 95% CI 0.36–0.68). Previous bleeding, index major bleeding, and lower glomerular filtration rate were associated with a higher risk of recurrent bleeding. The incidence of recurrent bleeding increased after anticoagulation restart independently of timing of resumption. Conclusions: Anticoagulant treatment after gastrointestinal bleeding is associated with a lower risk of thromboembolism and death, but higher risk of recurrent bleeding. The latter seemed to be influenced by patient characteristics and less impacted by time of anticoagulation resumption.
KW - anticoagulants
KW - gastrointestinal bleeding
KW - hemorrhage
KW - mortality
KW - thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85112608071&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.15476
DO - https://doi.org/10.1111/jth.15476
M3 - Article
C2 - 34318606
SN - 1538-7933
VL - 19
SP - 2618
EP - 2628
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 10
ER -