Choe A Reum, Moon Chang Mo, Tae Chung Hyun, Chun Jaeyoung, Bang Ki Bae, Lee Yoo Jin, Lee Hyun Seok, Jung Yunho, Park Sung Chul, Koo Hoon Sup
Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea.
Inflammation-Cancer Microenvironment Research Center, College of Medicine, Ewha Womans University, Seoul 07804, Korea.
J Clin Med. 2021 Jun 18;10(12):2693. doi: 10.3390/jcm10122693.
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA.
新型口服抗凝剂（NOACs）在临床实践中通常作为维生素K拮抗剂（VKA）的替代品使用。然而，胃肠道（GI）出血的病因、临床过程及风险仍不明确。我们旨在评估与NOACs相关的急性胃肠道出血的临床特征、部位，及其与VKA相比的严重程度和结局。这项回顾性多中心研究纳入了381名接受抗凝治疗且因胃肠道出血接受了适当诊断检查的受试者。关于急性胃肠道出血的特征，NOACs组血管病变的比例显著低于VKA组。小肠出血在NOACs组中较少见，但差异未达到统计学意义。关于严重程度和临床结局，与VKA组相比，使用NOACs的患者输注血液制品的量显著更少，入住重症监护病房（ICU）的时间更短。此外，NOACs组的手术需求和再出血风险显著低于VKA组。在急性胃肠道出血或再出血的严重程度方面，使用NOACs的患者比使用VKA的患者具有更好的临床结局。与使用VKA的患者相比，使用NOACs的患者表现出不同的急性胃肠道出血特征和部位。
