Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):381-389.e9. doi: 10.1016/j.cgh.2020.11.029. Epub 2020 Nov 21.
BACKGROUND & AIMS: Limited data exist on the management of anticoagulation after hospitalization for gastrointestinal bleeding (GIB) and the risks of recurrent GIB and thromboembolism in patients who are prescribed warfarin vs direct oral anticoagulants (DOACs). The purpose of this study was to assess the risk of recurrent GIB and thromboembolism with resumption of anticoagulation after GIB.
This was a retrospective analysis of adults with atrial fibrillation prescribed warfarin or DOACs and subsequently hospitalized for GIB. We used claims data from IBM MarketScan Databases from January 2008 through December 2017. Multivariable time-varying regression was used to determine the risks of recurrent GIB and thromboembolism within 6 months of the index hospitalization.
There were 2991 patients hospitalized for GIB on anticoagulants (warfarin, n = 1872; rivaroxaban, n = 676; dabigatran, n = 293; and apixaban, n = 250). Of warfarin users, 46% (n = 869) resumed warfarin after discharge compared with 43% (n = 483) of DOAC users who resumed DOACs. In the regression analysis modeling time-varying coefficients for anticoagulant use, warfarin resumption was associated with an increased risk of recurrent GIB (hazard ratio [HR], 2.12; 95% CI, 1.43-3.14; P = .0002) compared with no anticoagulant resumption, whereas there was no association with DOAC resumption and recurrent bleeding (HR, 1.43; 95% CI, 0.81-2.52; P = .22). Rivaroxaban was the only individual DOAC that was associated with recurrent GIB (HR, 2.73; 95% CI, 1.43-5.20; P = .002). Both warfarin (HR, 0.61; 95% CI, 0.39-0.96; P = .033) and DOAC (HR, 0.52; 95% CI, 0.28-0.98; P = .044) resumption as a class was associated with a decreased risk of thromboembolism.
Either warfarin or DOAC resumption after hospitalization for GIB was associated with a decreased risk of thromboembolism, whereas warfarin and rivaroxaban resumption were associated with an increased risk of recurrent GIB.
关于胃肠道出血 (GIB) 住院后抗凝治疗的管理以及接受华法林与直接口服抗凝剂 (DOAC) 治疗的患者复发出血和血栓栓塞的风险，目前仅有有限的数据。本研究旨在评估 GIB 后恢复抗凝治疗与复发出血和血栓栓塞的风险。
这是一项对使用华法林或 DOAC 并随后因 GIB 住院的成人进行的回顾性分析。我们使用了 2008 年 1 月至 2017 年 12 月 IBM MarketScan 数据库中的索赔数据。采用时间变化的多变量回归来确定索引住院后 6 个月内复发出血和血栓栓塞的风险。
共有 2991 例因 GIB 而接受抗凝治疗的患者（华法林组 n=1872；利伐沙班组 n=676；达比加群组 n=293；阿哌沙班组 n=250）。华法林组中，46%（n=869）的患者出院后恢复使用华法林，而 DOAC 组中 43%（n=483）的患者恢复使用 DOAC。在回归分析中，对抗凝药物使用的时间变化系数进行建模，与不恢复抗凝药物相比，恢复使用华法林与复发出血风险增加相关（风险比[HR]，2.12；95%置信区间[CI]，1.43-3.14；P=0.0002），而恢复使用 DOAC 与再次出血无关（HR，1.43；95%CI，0.81-2.52；P=0.22）。利伐沙班是唯一与复发出血相关的 DOAC（HR，2.73；95%CI，1.43-5.20；P=0.002）。华法林（HR，0.61；95%CI，0.39-0.96；P=0.033）和 DOAC（HR，0.52；95%CI，0.28-0.98；P=0.044）的恢复使用均与血栓栓塞风险降低相关。
GIB 住院后恢复使用华法林或 DOAC 与血栓栓塞风险降低相关，而恢复使用华法林和利伐沙班与复发出血风险增加相关。
