Direct Oral Anticoagulant Therapy Associated With Gastrointestinal Bleeding: Investigation of the Underlying Causes Responsible For This Complication
Document Type
Conference Proceeding
Publication Date
9-2019
Publication Title
Archives of Pathology and Laboratory Medicine
Abstract
Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases; however, both major and nonmajor bleeding events have been reported. Gastrointestinal (GI) bleeding is the most common bleeding complication in patients receiving DOACs. Design: This study investigates the underlying local diseases responsible for DOAC therapy–related GI bleeding. Results: There were 38 patients (16 males and 22 females); median age was 75 years (range, 58–90). All patients experienced DOAC therapy–related GI bleeding. All patients had GI specialist evaluation. Active hemorrhoid bleeding was found in 10 patients. Upper and/or lower GI endoscopic examination was performed in 33 patients (excluding 5 patients with hemorrhoid bleeding). Sixteen patients had endoscopic pathologic findings responsible for active bleeding and 12 had no evident active bleeding. The most common anatomic location of bleeding was duodenum (n ¼ 7), followed by stomach (n ¼ 5), colon (n ¼ 3), and esophagus (n ¼ 7). Pathologic findings were ulcer (n ¼ 7), vascular diseases (n ¼ 6), active inflammation with hemorrhage (n ¼ 2), and Mallory-Weiss tear (n ¼ 1). All patients, except 1, had anemia with hemorrhoid bleeding. Conclusions: Most patients (26/38) with DOAC therapy–associated GI bleeding have identifiable bleeding causing local diseases in this study. Hemorrhoid bleeding was most common. Ulcerative and vascular lesions in duodenum and stomach account for most underlying diseases identified by endoscopy. Since GI bleeding is the most common bleeding complication and responsible for clinically significant anemia in some patients, a special GI evaluation may be considered before DOAC therapy, especially in patients with prior history of ulcerative and vascular diseases.
Volume
143
Issue
9
First Page
e220
Last Page
e220
Recommended Citation
Wyrzykowski M, Xie M. Direct oral anticoagulant therapy associated with gastrointestinal bleeding: investigation of the underlying causes responsible for this complication. Arch Pathol Lab Med. 2019 Sep;143(9):e220. doi:10.5858/arpa.2019-0901-AB
DOI
10.5858/arpa.2019-0901-AB
Comments
College of American Pathologists Annual Meeting, September 21-25, 2019, Orlando, FL