title: Management and outcome of gastrointestinal bleeding in patients taking oral anticoagulants or antiplatelet drugs.
abstract: BACKGROUND
  Non-vitamin K dependent oral anticoagulants (NOACs) significantly decrease overall major bleeding rates compared with vitamin K antagonists (VKAs) but there is conflicting evidence regarding the relative risk of gastrointestinal bleeding. Since data regarding the types, the management, and the outcome of NOAC-associated gastrointestinal bleeding are scarce, we aimed to fill this gap by comparing cases of gastrointestinal bleeding associated with NOAC, VKA, or antiplatelet therapy.
  
  
  METHODS
  All major gastrointestinal bleeding events documented in the prospective Dresden NOAC registry were identified, and bleeding location, lesion type, endoscopic treatment, use of blood and coagulation factor transfusion, length of stay, and in-hospital mortality were compared with historical data from a large cohort of consecutive gastrointestinal bleeding patients.
  
  
  RESULTS
  In the 143 NOAC therapy cases, upper gastrointestinal tract bleeding was seen in 44.1%, lower gastrointestinal tract bleeding was seen in 42.0%, and no lesion could be identified in the remaining 14.0%. In contrast, upper gastrointestinal tract bleeding was commoner in the 185 VKA therapy cases (53.0%) and in the 711 antiplatelet therapy cases (68.1%). Among cases with upper gastrointestinal tract bleeding during VKA or antiplatelet therapy, 54.1% and 61.4% respectively presented with ulcers, compared with 27.0% for NOAC therapy. In contrast, hemorrhoid bleeding was the predominant lesion type for lower gastrointestinal tract bleeding with NOAC therapy, with a rate of 33.3%, compared with 10.6% with VKA therapy and 8.7% with antiplatelet therapy. NOAC-associated gastrointestinal bleeding resulted in comparatively low resource consumption, shorter hospitalization, and low in-hospital mortality (1.6%) compared with gastrointestinal bleeding historically seen with use of VKAs (in-hospital mortality 5.6%) or antiplatelet agents (in-hospital mortality 11.9%).
  
  
  CONCLUSIONS
  Gastrointestinal bleeding in NOAC recipients is different from that seen with VKA or antiplatelet therapy and has a better short-term prognosis.
authors.affiliation: Department of Gastroenterology, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Pannach
authors.affiliation: Department of Internal Medicine, St. Hedwig-Krankenhaus, 10115, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Goetze
authors.affiliation: Thrombosis Research, Department of Hematology, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Marten
authors.affiliation: Thrombosis Research, Department of Hematology, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schreier
authors.affiliation: Thrombosis Research, Department of Hematology, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Luise
authors.initials: L
authors.lastname: Tittl
authors.affiliation: Thrombosis Research, Department of Hematology, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. jan.beyer@uniklinikum-dresden.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet therapy; Gastrointestinal bleeding; Mortality; Oral anticoagulants