Supratherapeutic anticoagulation at presentation is associated with reduced mortality in nonvariceal upper gastrointestinal hemorrhage
Introduction: Warfarin is a widely used and easily reversible anticoagulant. Although bleeding is more likely in warfarin users, it may also be more readily treated. This retrospective observational case-control study compares the outcome o...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2014-07-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1377287 |
| Summary: | Introduction: Warfarin is a widely used and easily reversible
anticoagulant. Although bleeding is more likely in warfarin users, it may also
be more readily treated. This retrospective observational case-control study
compares the outcome of acute nonvariceal upper gastrointestinal hemorrhage in
warfarin users with a supratherapeutic international normalized ratio (INR) and
outcome in non – warfarin users.
Patients and methods: Clinical and endoscopic data for patients presenting
with overt upper gastrointestinal hemorrhage were collected between 23rd
February 2001 and 12 October 2010. Patients with variceal hemorrhage were
excluded. Warfarin users with a supratherapeutic INR (≥ 3.0) at presentation
(supratherapeutic anticoagulation [SA] group) were matched to a cohort with
upper gastrointestinal hemorrhage not taking warfarin at presentation (control
group). Patients were matched by age, sex, Rockall score, year of endoscopy,
inpatient or outpatient status, and the presence of disseminated cancer at
presentation. The incidence rates of major outcomes in the two groups were
compared.
Results: A total of 128 patients (SA group) were matched to 135 control
patients. The SA group patients were less likely to die within 30 days (6.25 %
vs. 15.5 %, odds ratio = 0.36, P = 0.028 by Test for Equality of
Proportions). There was a trend toward more surgery in the control group (5 %
vs. 2 %), and rates of blood transfusion (77 % vs. 70 %) were similar in the two
groups.
Conclusion: In patients presenting with nonvariceal upper gastrointestinal
hemorrhage, a supratherapeutic INR at presentation due to warfarin use is
associated with reduced mortality. |
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| ISSN: | 2364-3722 2196-9736 |