Department of Medicine, Memorial University of Newfoundland, Medical Education Centre, 300 Prince Philip Drive, St. John's, NL, Canada A1B 3V6.
Can J Gastroenterol Hepatol. 2019 Jun 18;2019:9851307. doi: 10.1155/2019/9851307. eCollection 2019.
Anticoagulants carry a significant risk of gastrointestinal bleeding. With the increase in use and availability of direct oral anticoagulants ("DOACs") more data are available regarding the risks of these medications. With diverticular bleeds being common, and hospitalization associated with gastrointestinal bleed increasing 30-day mortality, it is paramount to better understand the potential risks of using DOACs in this population.
A systematic review of the literature was undertaken, using the databases PubMed, EMBASE, Cochrane Library, and CINAHL. Two reviewers independently searched the literature, and initial screening was performed through title and abstract reading. Search terms included "direct" AND "anticoagulant" AND "diverticular bleed" OR "diverticular hemorrhage". The references of the selected studies were manually reviewed for any further relevant articles.
Literature search across the databases garnered 182 articles-157 unique abstracts after duplicate removal. Based on inclusion and exclusion criteria, 6 studies were deemed relevant. The selected studies' reference lists yielded no further relevant articles.
Across the 6 studies, the incidence of diverticular bleeding in patients using DOACs was extremely low. Of 23,990 patients taking DOACs identified from two separate institutions, only 60 were found to have diverticular hemorrhage. Similarly, among 15,056 patients with diverticular hemorrhage, only 246 (1.6%) among them were taking DOACs. Generally, the studies found no increased diverticular bleeding rate between patients taking DOACs and those who were taking other anticoagulants, such as warfarin, or the general population. The studies also did not find an increased risk of rebleeding with DOAC continuation.
The evidence suggests the risk of diverticular bleed among DOAC users is equivocal to those not taking DOACs, and the overall incidence of diverticular bleed in the DOAC population is low. As it stands, the risk of thrombotic events from not starting DOACs apparently outweighs the risk of diverticular bleed.
抗凝剂有发生胃肠道出血的重大风险。随着直接口服抗凝剂（“DOAC”）的使用和可获得性的增加，关于这些药物风险的数据也越来越多。由于憩室出血很常见，并且胃肠道出血相关的住院治疗会使 30 天死亡率增加，因此，更好地了解 DOAC 在这一人群中的潜在风险至关重要。
对文献进行了系统评价，使用了 PubMed、EMBASE、Cochrane 图书馆和 CINAHL 数据库。两名审查员独立搜索文献，通过标题和摘要阅读进行初步筛选。搜索词包括“直接”和“抗凝剂”和“憩室出血”或“憩室出血”。选择的研究的参考文献手动审查以获取任何其他相关文章。
数据库中的文献搜索共获得 182 篇文章-157 篇重复后唯一的摘要。根据纳入和排除标准，有 6 项研究被认为是相关的。所选研究的参考文献列表没有产生其他相关文章。
在这 6 项研究中，使用 DOAC 的患者憩室出血的发生率极低。在从两个独立机构确定的 23990 名服用 DOAC 的患者中，只有 60 名患者发现有憩室出血。同样，在 15056 名憩室出血患者中，只有 246 名（1.6%）服用 DOAC。一般来说，研究发现服用 DOAC 的患者与服用其他抗凝剂（如华法林）或一般人群相比，憩室出血的发生率没有增加。这些研究也没有发现 DOAC 继续使用会增加再出血的风险。
证据表明，DOAC 使用者发生憩室出血的风险与未服用 DOAC 的患者相似，而 DOAC 患者的总体憩室出血发生率较低。目前，不开始使用 DOAC 的血栓事件风险显然超过了憩室出血的风险。
