Anticoagulation Resumption After a GI Bleed Is Associated with Lower Mortality in AF
Hooman Kamel, MD reviewing Staerk L et al. BMJ 2015 Nov 16.
In an observational study, resumption of oral anticoagulant therapy after anticoagulation-related gastrointestinal bleeding was associated with lower mortality despite a higher risk for recurrent bleeding.
Anticoagulant drugs reduce stroke risk but increase bleeding risk in patients with atrial fibrillation (AF). AF patients receiving anticoagulant therapy often experience gastrointestinal (GI) bleeding, which is inconvenient and distressing at best and painful, costly, and lethal at worst. GI bleeding necessitates at least temporary cessation of anticoagulation. Whether and when to restart anticoagulation after the bleeding has resolved remains unclear. To address this uncertainty, Danish investigators used nationwide registry data to assess the relationship between anticoagulant use after GI bleeding and rates of stroke, recurrent bleeding, and death.
Among 4602 patients with AF who were receiving anticoagulation before a GI bleed, 27% did not resume any antithrombotic therapy within the subsequent 3 months, 21% resumed oral anticoagulation, and the remainder resumed a combination of anticoagulant and antiplatelet therapy. Over the next 2 years, approximately 40% died, 12% had a thromboembolic event, 12% had recurrent GI bleeding, and 17% had major bleeding. Compared with not restarting antithrombotic treatment, resumption of oral anticoagulation alone was associated with a significantly lower risk for all-cause mortality (hazard ratio, 0.39) and thromboembolism (HR, 0.41) even though it nonsignificantly increased the risk for recurrent GI bleeding (HR, 1.22; 95% confidence interval, 0.84–1.77) and significantly increased the overall risk for major bleeding (HR, 1.37; 95% CI, 1.06–1.77).
Citation(s):
Staerk L et al. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation: Nationwide cohort study. BMJ 2015 Nov 16; 351:h5876.
