title: Upper Digestive Bleeding in Atrial Fibrillation: Evaluation of Gastroscopy Prior to Oral Anticoagulant Therapy (GOAT), Prospective, Randomized, Double Blind Study on a Community Population.
abstract: BACKGROUND
  The aim of this study was to investigate the incidence of digestive hemorrhages in patients with non-valvular atrial fibrillation (NVAF), scheduled for oral anticoagulant therapy.
  
  
  METHODS
  We conducted, over 24 months, a prospective, randomized, population-based observational study on consecutive patients with recurrent paroxysmal, persistent, or permanent NVAF, scheduled for oral anticoagulant therapy. The study initially included 268 patients with NVAF (162 males and 106 females) with a mean age of 74 years (range 42-86 years). Patients were split into two groups: those undergoing preventive Esophago-Gastro-Duodenoscopy (EGD) (Group A) and those who did not (Group B). All patients positive by EGD underwent medical treatment and subsequent 30-day endoscopic controls showed complete healing. The primary outcome of the study was to determine if previous EGD in patients with NVAF resulted in a low risk of bleeding during oral anticoagulant therapy. The two groups were comparable for most variables.
  
  
  RESULTS
  Significant differences were found between groups for the incidence of antiarrhythmic drugs and for early hemorrhage (P<0.001). The incidences of early hemorrhages were significantly different between the two groups with 12 in group B (12%) and 2 in group A (1.7%).
  
  
  CONCLUSIONS
  Preventive EGD can identify hidden digestive diseases, which may increase the incidence of early hemorrhages.
authors.affiliation: Internal Medicine Department, Hospital of Santa Maria Nuova, Florence, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Lagi
authors.affiliation: Emergency Department, Hospital of Santa Maria Nuova, Florence, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Spini
authors.affiliation: Emergency Department, Hospital of Santa Maria Nuova, Florence, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Meucci
authors.affiliation: Emergency Department, Hospital of Santa Maria Nuova, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cartei
authors.affiliation: Emergency Department, Hospital of Santa Maria Nuova, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cencetti
keywords: Anticoagulation; Atrial fibrillation; Cohort study; Digestive hemorrhage; Risk factors