Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists

Abstract

Background: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, aetiology, and outcomes of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. AIMS:To evaluate the severity, aetiology and outcomes of GIB in patients under DOACs compared to VKA.Methods: Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcomes were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and type of support needed. Aetiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death.Results: A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients on VKA, and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between groups.Peptic disease was the most frequent aetiology of GIB in patients on VKA (20.2 % vs.13.6%, p=0.20). Diverticular bleeding was the most frequent in patients on DOAC (14.3% vs. 24.8%, p= 0.056).Conclusions: Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of aetiology of GIB.