Department of Emergency, Dongyang people's Hospital of Zhejiang Province, Dongyang, China.
J Clin Pharm Ther. 2021 Dec;46(6):1509-1518. doi: 10.1111/jcpt.13442. Epub 2021 Jun 7.
Long-term anticoagulant/antithrombotic therapy is widely used for the management of thromboembolic conditions. Gastrointestinal bleeding is a common collateral manifestation of anticoagulant/antithrombotic therapy that complicates its administration. The continuation or discontinuation of anticoagulant/antithrombotic therapy after an episode of gastrointestinal bleeding has been a matter of debate. Despite recent positive reports from retrospective cohort studies suggesting a reduction in morbidity- and mortality-related outcomes with continued administration of anticoagulant/antithrombotic agents (even after gastrointestinal bleeding), no consensus or comparisons about the efficacies of continued or discontinued antithrombotic administration exist. Therefore, we developed this current state-of-evidence analysis evaluating the comparative effects of continuation and discontinuation of anticoagulant/antithrombotic drugs after gastrointestinal bleeding on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events.
We performed a systematic academic literature search according to the PRISMA guidelines across five databases: Web of Science, Embase, CENTRAL, Scopus and MEDLINE. Moreover, we conducted a random effect meta-analysis to compare the effects of continuation and discontinuation of anticoagulant/antithrombotic drugs after an event of gastrointestinal bleeding on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events.
We found seven eligible studies (from 1397 candidates) with 2532 participants (mean age, 73.1 ± 4.1 years). Our meta-analysis revealed lower odds of thromboembolic events (OR, -0.21), mortality outcomes (OR, -0.39) and an increase in the incidence of gastrointestinal bleeding (OR, 2.4) in the group with continued anticoagulant/antithrombotic therapy than in the group discontinuing the therapy.
We provide an updated evidence on the comparative effects between continuation and discontinuation of anticoagulant/antithrombotic drugs after gastrointestinal bleeding events based on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events. This study reports confirm an overall lower incidence of thromboembolic events and mortality outcomes for the continuation group than for the discontinuation group.
长期抗凝/抗血栓治疗广泛用于血栓栓塞性疾病的治疗。胃肠道出血是抗凝/抗血栓治疗的常见并发症，使其治疗变得复杂。在胃肠道出血事件后，继续或停止抗凝/抗血栓治疗一直是一个有争议的问题。尽管最近来自回顾性队列研究的积极报告表明，继续使用抗凝/抗血栓药物（即使在胃肠道出血后）可以降低与发病率和死亡率相关的结果，但关于继续或停止抗血栓治疗的疗效尚无共识或比较。因此，我们进行了这项当前证据分析，评估了胃肠道出血后继续和停止抗凝/抗血栓药物对胃肠道出血、血栓栓塞事件和死亡率总体发生率的比较效果。
我们根据 PRISMA 指南，在五个数据库（Web of Science、Embase、CENTRAL、Scopus 和 MEDLINE）中进行了系统的学术文献搜索。此外，我们进行了随机效应荟萃分析，以比较胃肠道出血事件后继续和停止抗凝/抗血栓药物对胃肠道出血、血栓栓塞事件和死亡率总体发生率的影响。
我们发现了七项符合条件的研究（来自 1397 名候选者），共有 2532 名参与者（平均年龄 73.1 ± 4.1 岁）。我们的荟萃分析显示，继续抗凝/抗血栓治疗组发生血栓栓塞事件（OR，-0.21）、死亡率结局（OR，-0.39）的可能性较低，而胃肠道出血的发生率（OR，2.4）增加。
我们根据胃肠道出血、血栓栓塞事件和死亡率的总体发生率，提供了关于胃肠道出血事件后继续和停止抗凝/抗血栓药物的比较效果的最新证据。本研究报告证实，继续治疗组的血栓栓塞事件和死亡率结局总体上低于停药组。
