title: Impact of anticoagulation on upper-gastrointestinal bleeding in cirrhosis. A retrospective multicenter study.
abstract: Recent studies have shown that liver cirrhosis (LC) behaves as an acquired hypercoagulable state with increased thrombotic risk. This is why anticoagulation therapy (AT) is now frequently used in these patients. Variceal bleeding is a severe complication of LC. It is unknown whether AT may impact the outcome of bleeding in these patients. Fifty-two patients on AT with upper gastrointestinal bleeding (UGIB) were evaluated. Portal vein thrombosis (PVT) and different cardiovascular disorders (CVDs) were the indication for AT in 14 and 38 patients, respectively. Overall, 104 patients with LC and UGIB not under AT matched for severity of LC, age, sex, source of bleeding, and Sequential Organ Failure Assessment (SOFA) score served as controls. UGIB was attributed to portal hypertension (PH) in 99 (63%) patients and peptic/vascular lesions in 57 (37%). Twenty-six (17%) patients experienced 5-day failure; SOFA, source of UGIB, and PVT, but not AT, were independent predictors of 5-day failure. In addition, independent predictors of 6-week mortality, which was observed in 26 (11%) patients, were SOFA, Charlson Comorbidity index, and use of AT for a CVD. There were no differences between patients with/without AT in needs for rescue therapies, intensive care unit admission, transfusions, and hospital stay.
  
  
  CONCLUSIONS
  Factors that impact the outcome of UGIB in patients under AT are degree of multiorgan failure and comorbidity, but not AT itself.
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Federica
authors.initials: F
authors.lastname: Cerini
authors.affiliation: Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, Madrid, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Javier Martínez
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain.|Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Torres
authors.affiliation: Hepatology Unit, Gastroenterolgy Department, Marques de Valdecilla University Hospital, Marques de Valdecilla Investigation Institute (IDIVAL), Santander, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Puente
authors.affiliation: Liver Unit, Department of Gastroenterology, Corporación Sanitaria Parc Taulí. Sabadell, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Casas
authors.affiliation: Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vinaixa
authors.affiliation: Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.affiliation: Department of Gastroenterology, Hospital Sant Pau, Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Ardevol
authors.affiliation: Liver Unit-Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Augustin
authors.affiliation: Department of Gastroenterology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
authors.forename: Elba
authors.initials: E
authors.lastname: Llop
authors.affiliation: Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, (IISGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Senosiaín
authors.affiliation: Department of Gastroenterology, Hospital Sant Pau, Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Càndid
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: Hepatology Unit, Gastroenterolgy Department, Marques de Valdecilla University Hospital, Marques de Valdecilla Investigation Institute (IDIVAL), Santander, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: de la Peña
authors.affiliation: Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, (IISGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: Liver Unit-Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.|Department of Gastroenterology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Genescá
authors.affiliation: Liver Unit, Department of Gastroenterology, Corporación Sanitaria Parc Taulí. Sabadell, Barcelona, Spain.
authors.forename: Júlia
authors.initials: J
authors.lastname: Sopeña
authors.affiliation: Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, Madrid, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernández-Gea
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Spain.|CIBERehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagán
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants