title: Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome.
abstract: BACKGROUND
  Warfarin reduces the incidence of thromboembolism but increases the risk of gastrointestinal bleeding (GIB). GIB during warfarin anticoagulation is rarely evaluated in Asian patients.
  
  
  OBJECTIVE
  This study aimed at investigating the incidence, risk factors, management, and outcome of GIB in Taiwanese patients treated with warfarin.
  
  
  METHODS
  We analyzed a cohort of warfarin anticoagulated patients between July 1993 and May 2012. Clinical data were retrieved in a chart-reviewing manner.
  
  
  RESULTS
  A total of 401 warfarin anticoagulated patients were enrolled. The incidence of GIB was 3.9% per patient-years. Multivariate analysis with Cox regression showed that age >65 years old (RR: 2.5, 95% CI: 1.2-5.5), a mean international normalized ratio >2.1 (RR: 2.1, 95% CI: 1.0-4.2), a history of GIB (RR: 5.1, 95% CI: 1.9-13.5), and cirrhosis (RR: 6.9, 95% CI: 2.0-24.5) were independent factors predicting GIB. 27.3% of the GIB patients had rebleeding after restarting warfarin while thromboembolic events were found in 16.7% of the patients discontinuing warfarin therapy.
  
  
  CONCLUSIONS
  Warfarin was associated with a significant incidence of GIB in Taiwanese patients. The intensity of anticoagulation should be monitored closely during warfarin therapy, especially in patients with risk factors of GIB.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan ; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan ; Department of Chemistry, College of Science, National Kaohsiung Normal University, Kaohsiung 82444, Taiwan.
authors.forename: Wen-Chi
authors.identifier: 0000-0002-7572-4201
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan.
authors.forename: Yan-Hua
authors.identifier: 0000-0002-5241-258X
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan ; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan ; Department of Sport, Health & Leisure, Cheng Shiu University, Kaohsiung 83347, Taiwan.
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan ; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan.
authors.forename: Jin-Shiung
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan ; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
authors.forename: Kwok-Hung
authors.identifier: 0000-0002-3085-6534
authors.initials: KH
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D044466:Asian People; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin