Diamantopoulou Georgia, Konstantakis Christos, Skroubis George, Theocharis George, Theopistos Vasilios, Triantos Christos, Thomopoulos Konstantinos
Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Rio, Greece.
Department of Gastroenterology, General Hospital of Patras, 26300 Patras, Greece.
Gastroenterology Res. 2019 Feb;12(1):21-26. doi: 10.14740/gr1115. Epub 2019 Feb 26.
Acute lower gastrointestinal bleeding (ALGIB) can occur in patients on anticoagulant therapy (either warfarin or non-vitamin K oral anticoagulants (NOACs)). Use of NOACs has been increasing compared to warfarin in recent years. We analyzed patients with ALGIB on anticoagulation therapy and compared characteristics, management and clinical outcome in patients treated with NOACs versus warfarin.
All patients with ALGIB on anticoagulation therapy treated in two (affiliated) centers during a 7-year period were evaluated. Characteristics and clinical outcome were compared between patients on warfarin and patients on NOACs.
Out of the 587 patients identified with ALGIB during the study period, 43 (7.3%) were on NOACs and 68 (11.6%) on warfarin. Mean age was 75.9 ± 9.5 and 77.1 ± 7.9 years respectively. Site of bleeding was located in the small bowel in 2/43 of NOAC patients and 6/68 of warfarin group. Vascular ectasias (8/43 vs. 6/68, P = 0.010) and polyps/neoplasia (13/43 vs. 6/68, P = 0.025) were more commonly causes of bleeding in patients on NOACs. While endoscopic hemostasis was more commonly needed in patients on NOACs (17/43 vs. 14/68, P = 0.049), they required less hospitalization days (4.5 ± 3.6 vs. 6.1 ± 4.2, P = 0.032). Blood transfusions and need for other interventions (embolization and/or surgery) as well as recurrence of bleeding and mortality were not statistically different.
Although NOAC patients with ALGIB exhibit some differences on certain clinical characteristics when compared to warfarin patients, they share a similar clinical outcome.
急性下消化道出血（ALGIB）可发生于接受抗凝治疗（华法林或非维生素K口服抗凝剂（NOACs））的患者中。近年来，与华法林相比，NOACs的使用一直在增加。我们分析了接受抗凝治疗的ALGIB患者，并比较了接受NOACs与华法林治疗的患者的特征、治疗方法及临床结局。
对两个（附属）中心在7年期间治疗的所有接受抗凝治疗的ALGIB患者进行评估。比较服用华法林的患者和服用NOACs的患者的特征及临床结局。
在研究期间确定的587例ALGIB患者中，43例（7.3%）服用NOACs，68例（11.6%）服用华法林。平均年龄分别为75.9±9.5岁和77.1±7.9岁。NOAC组43例中有2例、华法林组68例中有6例的出血部位位于小肠。血管扩张（8/43 vs. 6/68，P = 0.010）和息肉/肿瘤（13/43 vs. 6/68，P = 0.025）在服用NOACs的患者中更常见于出血原因。虽然服用NOACs的患者更常需要内镜止血（17/43 vs. 14/68，P = 0.049），但他们住院天数更少（4.5±3.6 vs. 6.1±4.2，P = 0.032）。输血以及其他干预措施（栓塞和/或手术）的需求以及出血复发和死亡率无统计学差异。
虽然与服用华法林的患者相比，患有ALGIB的NOAC患者在某些临床特征上存在一些差异，但他们的临床结局相似。
