Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea.
Division of Cardiology, Chamjoeun Hospital, Gwangju-si, Republic of Korea.
PLoS One. 2022 Jun 3;17(6):e0269262. doi: 10.1371/journal.pone.0269262. eCollection 2022.
Acute gastrointestinal (GI) bleeding is not an uncommon complication of oral anticoagulation (OAC) therapy that requires medication cessation. However, drug cessation may cause fatal stroke or systemic embolization in patients at high thromboembolic risk. Here we sought to find an appropriate anticoagulation cessation strategy in cases of GI bleeding during OAC therapy.
This single-center retrospective cohort analysis was performed between 2010 and 2018. Patients were enrolled if the following three consecutive conditions were met: 1) electrocardiography electrocardiography-proven atrial fibrillation; 2) OAC therapy; and 3) GI bleeding. We divided the drug cessation strategy into the continuation and discontinuation groups. During 1-year follow-up, the rates of major thromboembolic and rebleeding events were calculated.
One hundred and forty-six patients (continuation [n = 54] vs. discontinuation [n = 92] group) were enrolled. Patients in the discontinuation group were more likely to be older (69.8 ± 9.0 yrs vs. 74.9 ± 8.9 yrs, p = 0.001), while patients in the continuation group were more likely to have undergone cardiac valve surgery (51.9% vs. 20.7%, p<0.001). The presence of a mechanical mitral valve was a determinant of continuation strategy (38.9% vs. 7.5%, p<0.001). However, the mean CHA₂DS₂-VASc (3.4±1.3 vs. 4.1±1.6, p = 0.010) and Glasgow-Blatchford (8.0±2.4 vs. 8.9±2.5, p = 0.037) scores were higher in the discontinuation group. Two major embolic strokes occurred in each group (3.7% vs. 2.2%, p = 0.585). Four of 54 (7.4%) and five of 92 (5.4%) patients had rebleeding events during follow-up (p = 0.632). One embolic event in the continuation group and one rebleeding event in the discontinuation group were fatal. The Glasgow-Blatchford score was a predictor of 1-year rebleeding events (odds ratio [OR], 1.36; 95% confidence interval [CI], 0.68-2.20; p = 0.028). The high CHA₂DS₂-VASc score showed a strong trend (OR, 1.71; 95% CI, 0.92-3.20; p = 0.089) in 1-year thromboembolic events.
No single risk factor or drug cessation strategy was attributed to adverse clinical events after GI bleeding. The risk of future thrombotic or rebleeding events should be individualized and controlled for based on a pre-existing stratification system.
口服抗凝治疗（OAC）导致的急性胃肠道（GI）出血并不少见，需要停止用药。然而，停药可能会导致高血栓栓塞风险的患者发生致命性中风或全身性栓塞。在这里，我们试图在 OAC 治疗期间发生 GI 出血的情况下找到一种合适的抗凝停药策略。
这是一项 2010 年至 2018 年期间进行的单中心回顾性队列分析。如果满足以下三个连续条件，则纳入患者：1）心电图证实心房颤动；2）OAC 治疗；3）GI 出血。我们将药物停药策略分为继续和停止两组。在 1 年随访期间，计算主要血栓栓塞和再出血事件的发生率。
共纳入 146 名患者（继续组 [n = 54] 与停止组 [n = 92]）。停止组的患者年龄更大（69.8 ± 9.0 岁 vs. 74.9 ± 8.9 岁，p = 0.001），而继续组的患者更可能接受过心脏瓣膜手术（51.9% vs. 20.7%，p<0.001）。机械二尖瓣的存在是继续治疗策略的决定因素（38.9% vs. 7.5%，p<0.001）。然而，停止组的平均 CHA₂DS₂-VASc（3.4±1.3 vs. 4.1±1.6，p = 0.010）和格拉斯哥-布拉奇福德（8.0±2.4 vs. 8.9±2.5，p = 0.037）评分更高。两组各有 2 例主要栓塞性中风（3.7% vs. 2.2%，p = 0.585）。54 名患者中有 4 名（7.4%）和 92 名患者中有 5 名（5.4%）在随访期间出现再出血事件（p = 0.632）。继续组有 1 例栓塞事件和停止组有 1 例再出血事件致死。格拉斯哥-布拉奇福德评分是 1 年内再出血事件的预测因素（比值比 [OR]，1.36；95%置信区间 [CI]，0.68-2.20；p = 0.028）。高 CHA₂DS₂-VASc 评分在 1 年内血栓栓塞事件中具有强烈趋势（OR，1.71；95%CI，0.92-3.20；p = 0.089）。
没有单一的危险因素或药物停药策略与 GI 出血后不良临床事件有关。未来血栓形成或再出血事件的风险应根据预先存在的分层系统进行个体化和控制。
