No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis
Background: There are recommendations for anticoagulation resumption after gastrointestinal bleeding (GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated patients is lacking. We aim to determine the safety and efficacy of restarting DOACs after GIB. Methods: Studi...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-02-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/11/2/554 |
| _version_ | 1827758424253792256 |
|---|---|
| author | Dániel Pálinkás Brigitta Teutsch Endre Botond Gagyi Marie Anne Engh Patrícia Kalló Dániel S. Veres László Földvári-Nagy Nóra Hosszúfalusi Péter Hegyi Bálint Erőss |
| author_facet | Dániel Pálinkás Brigitta Teutsch Endre Botond Gagyi Marie Anne Engh Patrícia Kalló Dániel S. Veres László Földvári-Nagy Nóra Hosszúfalusi Péter Hegyi Bálint Erőss |
| author_sort | Dániel Pálinkás |
| collection | DOAJ |
| description | Background: There are recommendations for anticoagulation resumption after gastrointestinal bleeding (GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated patients is lacking. We aim to determine the safety and efficacy of restarting DOACs after GIB. Methods: Studies that reported rebleeding, thromboembolic events, and mortality after restarting or withholding DOACs were selected. The systematic research was conducted in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Scopus). The random effect model was implemented to calculate the pooled odds ratio (OR). The ROBINS-I tool was used for risk of bias assessment, and the certainty of the evidence was evaluated with the GRADE approach. Results: Four retrospective cohort studies (1722 patients) were included in the meta-analysis. We did not find a significant increase in the risk of rebleeding in patients restarting DOACs after index GIB (OR = 1.12; 95% CI: 0.74–1.68). The outcomes of thromboembolic events and mortality data were not suitable for meta-analytic calculations. Single studies did not show statistically significant differences. Data quality assessment showed a serious overall risk of bias and very low quality of evidence (GRADE D). Conclusion: DOAC resumption after a GIB episode may not elevate the risk of rebleeding. However, the need for high-quality randomized clinical trials is crucial. |
| first_indexed | 2024-03-11T09:07:09Z |
| format | Article |
| id | doaj.art-9ab3bd112a5d4543b8758f2312500c05 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-11T09:07:09Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-9ab3bd112a5d4543b8758f2312500c052023-11-16T19:19:57ZengMDPI AGBiomedicines2227-90592023-02-0111255410.3390/biomedicines11020554No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-AnalysisDániel Pálinkás0Brigitta Teutsch1Endre Botond Gagyi2Marie Anne Engh3Patrícia Kalló4Dániel S. Veres5László Földvári-Nagy6Nóra Hosszúfalusi7Péter Hegyi8Bálint Erőss9Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryInstitute for Translational Medicine, Medical School, University of Pécs, H-7622 Pécs, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryDepartment of Morphology and Physiology, Faculty of Health Science, Semmelweis University, H-1088 Budapest, HungaryDepartment of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, H-1085 Budapest, HungaryBackground: There are recommendations for anticoagulation resumption after gastrointestinal bleeding (GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated patients is lacking. We aim to determine the safety and efficacy of restarting DOACs after GIB. Methods: Studies that reported rebleeding, thromboembolic events, and mortality after restarting or withholding DOACs were selected. The systematic research was conducted in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Scopus). The random effect model was implemented to calculate the pooled odds ratio (OR). The ROBINS-I tool was used for risk of bias assessment, and the certainty of the evidence was evaluated with the GRADE approach. Results: Four retrospective cohort studies (1722 patients) were included in the meta-analysis. We did not find a significant increase in the risk of rebleeding in patients restarting DOACs after index GIB (OR = 1.12; 95% CI: 0.74–1.68). The outcomes of thromboembolic events and mortality data were not suitable for meta-analytic calculations. Single studies did not show statistically significant differences. Data quality assessment showed a serious overall risk of bias and very low quality of evidence (GRADE D). Conclusion: DOAC resumption after a GIB episode may not elevate the risk of rebleeding. However, the need for high-quality randomized clinical trials is crucial.https://www.mdpi.com/2227-9059/11/2/554non-vitamin K antagonist oral anticoagulant (NOAC)gastrointestinal hemorrhagetherapy resumptionsafetyefficacy |
| spellingShingle | Dániel Pálinkás Brigitta Teutsch Endre Botond Gagyi Marie Anne Engh Patrícia Kalló Dániel S. Veres László Földvári-Nagy Nóra Hosszúfalusi Péter Hegyi Bálint Erőss No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis Biomedicines non-vitamin K antagonist oral anticoagulant (NOAC) gastrointestinal hemorrhage therapy resumption safety efficacy |
| title | No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis |
| title_full | No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis |
| title_fullStr | No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis |
| title_short | No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis |
| title_sort | no association between gastrointestinal rebleeding and doac therapy resumption a systematic review and meta analysis |
| topic | non-vitamin K antagonist oral anticoagulant (NOAC) gastrointestinal hemorrhage therapy resumption safety efficacy |
| url | https://www.mdpi.com/2227-9059/11/2/554 |
| work_keys_str_mv | AT danielpalinkas noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT brigittateutsch noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT endrebotondgagyi noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT marieanneengh noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT patriciakallo noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT danielsveres noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT laszlofoldvarinagy noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT norahosszufalusi noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT peterhegyi noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis AT balinteross noassociationbetweengastrointestinalrebleedinganddoactherapyresumptionasystematicreviewandmetaanalysis |