Coagulation

Upper GI bleeds: comorbidities more important than choice of anticoagulant


The type of oral anticoagulant – DOACs versus vitamin K antagonists (VKA) – has no influence on mortality following upper GI bleeding.

A French study of 475 consecutive patients with upper GI bleeding before or during hospital admission found slightly more than half (54.6%) were on VKA antagonists as opposed to DOACs.

Baseline characteristics were roughly similar although kidney failure and cirrhosis were more common in the VKA group.

The study found mortality at 6 weeks was 7.8% with DOACs compared to 16.1% with VKA (p = 0.0059) however mortality directly related to upper GI bleeding were similar in both groups (12.5% v 13.9%).

Other causes of death included multiple organ failure, cardiorespiratory failure and cancer.

The study found the Charlson index (OR = 4.02, 95%CI [2.16-7.44], P < 0.0001) and being an in-patient (OR = 2.96 [1.5-5.7], P = 0.0013) were the only factors associated with mortality.

“The type of oral anticoagulation (DOACs vs VKA) had no influence on mortality (OR = 0.53 [0.27-1.04], P = 0.068),” the study said.

As well, the study found no differences between the groups in terms of initial severity of the bleeding, endoscopic diagnosis and management, and effectiveness of bleeding resolution.

“Mortality in the VKA group was higher than in the DOACs group (p = 0.0059), potentially related to the comorbidities that contraindicate the use of DOACs such as kidney failure and cirrhosis over-represented in the VKA group,” the study said.

They concluded that DOACs do not alter the outcomes of upper GI bleeding as compared to VKA.

An editorial in the AP& T journal said it was helpful to have the new findings, especially given the increasing proportion of the population on DOACs in place of VKAs.

“The granular findings are a welcome addition to the evidence available for clinicians wrestling with which class of anticoagulant to use for patients to minimise their risk of severe adverse events from acute UGIB.”

“This study suggests that the underlying patient condition may be more of a risk factor for death than the specific type of anticoagulant.”

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