Kirita Kumiko, Kodaka Yasuhiro, Shibata Yoshiaki, Ueki Nobue, Agawa Shuhei, Yamawaki Hiroshi, Niikura Ryota, Yamamichi Nobutake, Izumi Kentaro, Hojo Mariko, Maruyama Kyohei, Yamamoto Takatsugu, Gudis Katya, Watanabe Masanori, Kaise Mitsuru, Iwakiri Katsuhiko, Futagami Seiji
Division of Gastroenterology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan.
Division of Gastroenterology, Tama-Hokubu Medical Center, Higashimurayama-shi, Tokyo 189-8511, Japan.
J Clin Biochem Nutr. 2021 Sep;69(2):222-228. doi: 10.3164/jcbn.20-140. Epub 2021 Apr 3.
Since there were no available data about colonic diverticular bleeding in extremely elderly patients (>80 years old) treated with direct oral anticoagulants (DOACs), we tried to determine clinical characteristics in those with colonic diverticular bleeding taking DOACs and to compare clinical outcomes of those in DOAC-treated to those in warfarin-treated . We enrolled DOAC-treated ( = 20) and warfarin-treated ( = 23) extremely elderly patients with diverticular bleeding diagnosed by colonoscopy. We performed a retrospective review of patients' medical charts and endoscopic findings. We classified colonic diverticular bleeding based on endoscopic features due to modified previous study following three groups, type A (active bleeding), type B (non-active bleeding) and type C (bleeding suspected). Clinical outcomes such as number of recurrent bleeding, thrombotic events and mortality were estimated. There were no differences in endoscopical features and clinical characteristics between patients treated with DOAC and warfarin therapy. However, the number of recurrent bleeding, frequency of required blood transfusions and units of blood transfusion in warfarin-treated patients were significantly higher (<0.05) compared to those in DOAC-treated groups. In addition, mortality and thrombotic events did not differ between DOAC- and warfarin-treated patients. Clinical outcomes suggest that DOACs can be recommended for extremely elderly patients with colonic diverticular disease.
由于缺乏关于使用直接口服抗凝剂（DOACs）治疗的极高龄患者（>80岁）结肠憩室出血的可用数据，我们试图确定服用DOACs的结肠憩室出血患者的临床特征，并比较DOAC治疗组和华法林治疗组的临床结局。我们纳入了经结肠镜检查诊断为憩室出血的使用DOAC治疗的（n = 20）和使用华法林治疗的（n = 23）极高龄患者。我们对患者的病历和内镜检查结果进行了回顾性分析。根据先前研究的改良方法，我们根据内镜特征将结肠憩室出血分为三组，A型（活动性出血）、B型（非活动性出血）和C型（疑似出血）。估计了复发出血次数、血栓形成事件和死亡率等临床结局。使用DOAC和华法林治疗的患者在内镜特征和临床特征方面没有差异。然而，与DOAC治疗组相比，华法林治疗组的复发出血次数、所需输血频率和输血量显著更高（<0.05）。此外，DOAC治疗组和华法林治疗组之间的死亡率和血栓形成事件没有差异。临床结局表明，DOACs可推荐用于患有结肠憩室病的极高龄患者。
