Napaporn Nawarawong MD1, Supot Pongprasobchai MD1, Tawesak Tanwandee MD1
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Acute gastrointestinal [GI] bleeding is common in anticoagulant users. Optimal management regarding the role of
endoscopy is lacking. This study aimed to elucidate the prevalence of significant endoscopic lesions and predictors of
significant lesions and management change with endoscopy.
Materials and Methods : A retrospective cohort study of anticoagulated patients with GI bleeding who underwent endoscopy
between January 2005 and December 2014 were reviewed and analyzed.
Results : There were 94 patients. Male and female were equal in number with a mean age of 71.6+10.8 years. Most (81.8%)
received warfarin. Upper GI bleeding was the most common site (60.9%) followed by lower GI bleeding (28.2%), mid GI
bleeding (5.5%) and undetermined (2.7%). Significant GI lesions were found in 62.7%. Peptic ulcer and colonic diverticulosis
were the 2 most common causes (41.8% and 28.2%, respectively). Bleeding from coagulopathy occurred in 26.4%. Significant
GI lesions led to the change of management in 53.6%, mostly with endoscopic therapy. Hematochezia (odds ratio [OR] 4.90,
95% confidence interval [CI] 1.22 to 19.50, p = 0.024) and INR <4 (OR 4.07, 95% CI 1.17 to 14.27, p = 0.028) were
associated with significant GI lesions, while concomitant antiplatelets was negatively associated with significant lesions (OR
0.32, 95% CI 0.12 to 0.88, p = 0.027). Hematochezia at presentation (OR 3.64, 95% CI 1.27 to 10.53, p = 0.016) and no use
of antiplatelets (OR 0.28, 95% CI 0.09 to 0.89, p = 0.031) were associated with the change of management.
Conclusion : Significant GI lesions were present in two-third of anticoagulated patients who had acute GI bleeding and led
to the change of management in one-third. Hematochezia, INR <4 and no concomitant antiplatelets predicted significant GI
lesions. Hematochezia and no concomitant antiplatelets predicted the change of management, mostly with endoscopic
therapy.
Keywords : Anticoagulant, Endoscopy, Gastrointestinal bleeding, Predictor, Outcome
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