Comparative Outcomes of Warfarin vs. Direct Oral Anticoagulants (DOACs) in Anticoagulant-Related Gastrointestinal Bleeding: A Single-Center Study.

BACKGROUND

The management of thromboembolic risk and the necessity for timely hemorrhage control make anticoagulant-related gastrointestinal (GI) bleeding clinically challenging.

OBJECTIVE

This study aimed to evaluate clinical outcomes (such as bleeding control and mortality) and the effectiveness of anticoagulation reversal techniques in patients with anticoagulant-related GI bleeding in emergency settings.

METHODOLOGY

This prospective, observational study conducted at Lady Reading Hospital, Peshawar, from January to December 2023, included patients aged 18 or older with GI bleeding on warfarin or direct oral anticoagulants (DOACs). Key clinical data, including demographics and comorbidities, were collected. The study followed a multidisciplinary approach with emergency physicians, gastroenterologists, and surgeons. Pharmacologic management (Vitamin K for warfarin and idarucizumab for DOACs) was initiated based on clinical judgment, with endoscopic interventions performed within 24 hours if needed, and surgical intervention considered if other methods failed or complications arose. Outcomes such as bleeding control, transfusion needs, and mortality were tracked. Data were collected prospectively via case report forms, and patients were followed for up to six months post-discharge. Statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY), with descriptive statistics for all variables. Continuous variables were compared using independent t-tests, and categorical data were assessed using chi-square tests. Adjusted odds ratios were calculated for mortality and bleeding control outcomes, accounting for confounders.  Results: A total of 384 patients were included, with 180 (46.88%) on warfarin and 204 (53.12%) on DOACs. Bleeding control was significantly better in the DOAC group (170/204, 83.33% vs. 130/180, 72.22%, = 0.03), while mortality was higher in patients on warfarin (20, 11.11% vs. 10, 4.90%, = 0.02). Patients on warfarin also had longer hospital stays (6.89 vs. 5.52 days, = 0.01) and times to intervention (5.28 vs. 4.64 hours, = 0.03). Although demographic characteristics (e.g., age and gender) and comorbidities (e.g., hypertension and diabetes) were comparable between groups, DOACs showed safer profiles during hospitalization. Long-term follow-up outcomes, including readmission rates, recurrent bleeding, and post-discharge mortality, were similar across both groups.

CONCLUSIONS

The study demonstrates that DOACs offer better outcomes in bleeding control and mortality compared to warfarin in anticoagulant-related GI bleeding, emphasizing the importance of tailored treatment strategies. These findings highlight the potential benefits of DOACs in emergency settings, supporting the need for customized management plans to optimize patient outcomes.