Award: Presidential Poster Award
Natalie Tapaskar, MD1, Sandra A. Ham, MS1, Neil Sengupta2
1The University of Chicago, Chicago, IL; 2University of Chicago Medical Center, Chicago, IL
Introduction: There is limited data on the management of anticoagulation following hospitalization for gastrointestinal bleeding (GIB) and the subsequent risks of recurrent GIB and thromboembolism in patients who are on warfarin compared to direct oral anticoagulants (DOACs).
Methods: We conducted a retrospective analysis of medical claims data from the IBM® MarketScan® Research Databases from January 1, 2008 through December 31, 2017. We collected data on adults with atrial fibrillation treated with warfarin or DOACs and subsequently hospitalized for GIB. Post discharge readmissions for recurrent GIB and thromboembolism within 180 days of initial discharge were reviewed. Univariable and multivariable cox regression were used to determine risks of recurrent GIB and thromboembolism.
Results: There were 2,991 patients hospitalized for GIB while on anticoagulants (warfarin, n=1872; rivaroxaban, n=676; dabigatran, n=293; apixaban, n=250). Differences between warfarin and DOAC users are reported in Table 1. Twenty-nine percent (n=869) of warfarin users had warfarin resumed following discharge with a median time to resumption of 27 days (IQR 10-63), compared to 16% percent (n=485) of DOAC users who had DOAC resumed (median time to resumption of 32 days (IQR 16-69). Discharge on warfarin was associated with the highest risk of recurrent GIB (HR 1.69, 95% CI 1.23-2.31) whereas discharge on dabigatran (HR 0.13, 95% CI 0.02-0.90) and apixaban (HR 0.38, 95% CI 0.14-1.01) had the lowest risk of recurrent GIB (Table 2). In a multivariable model adjusting for demographics, comorbidities, in-hospital management, source of bleeding, and post-discharge anticoagulant resumption, resumption of warfarin was associated with an increased risk of recurrent GIB (HR 1.53, 95% CI 1.07-2.18) compared to resumption of DOAC (HR 0.85, 95% CI 0.51-1.42). Variables associated with thromboembolism on multivariable regression included preceding venous thromboembolism (HR 2.42, 95% CI 1.66-3.51) and history of left ventricular assist device (HR 7.84, 95% CI 3.20-19.2). Survival analysis showed a significant association between type of anticoagulant on discharge and risk of recurrent GIB (log-rank, p= 0.001) (Figure 1).
Discussion: Resumption of warfarin following hospitalization for gastrointestinal bleeding was associated with an increased risk of recurrent GIB when compared to DOACs.
Citation: Natalie Tapaskar, MD; Sandra A. Ham, MS; Neil Sengupta. P0399 - RISKS OF RECURRENT BLEEDING IN PATIENTS HOSPITALIZED WITH GASTROINTESTINAL BLEEDING WHILE ON WARFARIN VS DIRECT ORAL ANTICOAGULANTS. Program No. P0399. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.