TBA (19W192)

New oral anticoagulant use and upper gastrointestinal bleeding, a single centre retrospective study.

Author(s)

L Coffey, E Connolly , R Varley , L Piggott, , D O Toole, S Mc Kiernan, F MacCarthy , D Kevans , K Hartery

Department(s)/Institutions

Department of Gastroenterology, St. James's Hospital, Dublin 8

Introduction

Upper gastrointestinal (GI) bleeding is a common cause of admission to hospital, and is associated with significant mortality. Glasgow Blatchford Score (GBS) is a risk scoring tool used to predict the need to treat patients presenting with upper GI bleeding. Use of new oral anticoagulants (NOAC) is becoming increasingly more common in our ageing co-morbid population.

Aims/Background

Here in, we review outcomes in patients admitted with upper GI bleeding over a 10 month period in our centre.

Method

Retrospective study analysing electronic endoscopy database from an academic teaching hospital from October 2018 to August 2019. All OGDs performed due to the indication of haematemesis, melaena and anaemia analyzed. Patients were excluded if procedure was performed as an outpatient. Clinical data and endoscopy reports were obtained from patient’s electronic health record.

Results

251 inpatient upper GI endoscopies were performed for the indication of haematemesis (n=59), meleana (n=77) and anaemia (n=159). 48 (18.7%) patients were on NOAC, of which 27% (n=13) were also on concomitant antiplatelet therapy. In our cohort, GBS correlated with need for transfusion (p=0.001) and endoscopic intervention (p=0.03). NOAC use was associated with higher GBS score (8 vs 7, p <0.05). There was a significant association between combined NOAC and antiplatelet use and severity of haemorrhage assessed by transfusion requirement (p=0.04). This was not observed with in NOAC alone (p=0.21).

Conclusions

The study further validates the use of GBS in clinical setting. Combined NOAC and antiplatelet use was associated with a higher transfusion requirement. Rationalisation of combined NOAC and antiplatelet use should be considered, where possible.