title: [Gastrointestinal lesions and characteristics of acute gastrointestinal bleeding in acenocoumarol-treated patients].
abstract: In the last few years, the number of anticoagulated patients has significantly increased and, as a consequence, so have hemorrhagic complications due to this therapy. We analyzed gastrointestinal (GI) bleeding because it is the most frequent type of major bleeding in these patients, and we hypothesized that they would have lesions responsible for GI bleeding regardless of the intensity of anticoagulation, although excessively anticoagulated patients would have more serious hemorrhages.
  
  
  OBJECTIVE
  To study the characteristics of anticoagulated patients with GI bleeding and the relationship between the degree of anticoagulation and a finding of causative lesions and bleeding severity.
  
  
  METHODS
  We prospectively studied 96 patients, all anticoagulated with acenocoumarol and consecutively admitted to hospital between 01/01/2003 and 09/30/2005 because of acute GI bleeding. We excluded patients with severe liver disease, as well as nine patients with incomplete details.
  
  
  RESULTS
  The incidence of GI bleeding requiring hospitalization was 19.6 cases/100,000 inhabitants-year. In 90% of patients, we found a causative (85% of upper GI bleeding and 50% of lower GI bleeding) or potentially causative lesion, and 30% of them required endoscopic treatment, without differences depending on the intensity of anticoagulation. No relationship was found between the type of lesions observed and the degree of anticoagulation in these patients. Patients who received more intense anticoagulation therapy had more severe hemorrhages (23% of patients with an INR ≥4 had a life-threatening bleed versus only 4% of patients with INR <4).
  
  
  CONCLUSIONS
  We found an incidence of 20 severe GI bleeding episodes in anticoagulated patients per 100,000 inhabitants-year, with no difference in localization or in the frequency of causative lesions depending on the intensity of anticoagulation. Patients receiving more intense anticoagulation had more severe GI bleeding episodes.
authors.affiliation: Servicio de Aparato Digestivo-A, Complejo Hospitalario de Navarra, Pamplona, España. Electronic address: onantes@yahoo.es.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Nantes
authors.affiliation: Servicio de Aparato Digestivo-A, Complejo Hospitalario de Navarra, Pamplona, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Zozaya
authors.affiliation: Laboratorio de Trombosis y Hemostasia, Área de Ciencias Cardiovasculares, CIMA de la Universidad de Navarra, Pamplona, España.
authors.forename: Ramón
authors.initials: R
authors.lastname: Montes
authors.affiliation: Laboratorio de Trombosis y Hemostasia, Área de Ciencias Cardiovasculares, CIMA de la Universidad de Navarra, Pamplona, España.
authors.forename: José
authors.initials: J
authors.lastname: Hermida
mesh_terms: D000074:Acenocoumarol / Q000009:adverse effects* / Q000627:therapeutic use; D000208:Acute Disease; D018256:Adenomatous Polyps / Q000150:complications* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000150:complications* / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000453:epidemiology; D004941:Esophagitis / Q000150:complications / Q000453:epidemiology; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000453:epidemiology; D006484:Hemorrhoids / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000150:complications* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D000074:Acenocoumarol
keywords: Acenocoumarol; Acenocumarol; Anticoagulantes; Anticoagulants; Gastrointestinal hemorrhage; Hemorragia digestiva