Is endoscopic therapy safe for upper gastrointestinal bleeding in anticoagulated patients with supratherapeutic international normalized ratios?

Choong Nam Shim, Hyun Soo Chung, Jun Chul Park, Sung Kwan Shin, SangKil Lee, Yongchan Lee, Ha Yan Kim, Dong Wook Kim, Hyuk Lee

Research output: Contribution to journalArticle

Abstract

The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n 168) and rebleeding group (n 24). The overall rebleeding rate was 12.5%. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95% confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95% confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.

Original languageEnglish
Pages (from-to)e995-e1003
JournalAmerican Journal of Therapeutics
Volume23
Issue number4
DOIs
Publication statusPublished - 2016 Aug 1

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International Normalized Ratio
Hemorrhage
Therapeutics
Stomach Neoplasms
Length of Stay
Multivariate Analysis
Odds Ratio
Confidence Intervals
Melena
Hematemesis
Gastrointestinal Hemorrhage
Duodenum
Endoscopy
Safety

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)

Cite this

Shim, Choong Nam ; Chung, Hyun Soo ; Park, Jun Chul ; Shin, Sung Kwan ; Lee, SangKil ; Lee, Yongchan ; Kim, Ha Yan ; Kim, Dong Wook ; Lee, Hyuk. / Is endoscopic therapy safe for upper gastrointestinal bleeding in anticoagulated patients with supratherapeutic international normalized ratios?. In: American Journal of Therapeutics. 2016 ; Vol. 23, No. 4. pp. e995-e1003.
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abstract = "The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n 168) and rebleeding group (n 24). The overall rebleeding rate was 12.5{\%}. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95{\%} confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95{\%} confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.",
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Is endoscopic therapy safe for upper gastrointestinal bleeding in anticoagulated patients with supratherapeutic international normalized ratios? / Shim, Choong Nam; Chung, Hyun Soo; Park, Jun Chul; Shin, Sung Kwan; Lee, SangKil; Lee, Yongchan; Kim, Ha Yan; Kim, Dong Wook; Lee, Hyuk.

In: American Journal of Therapeutics, Vol. 23, No. 4, 01.08.2016, p. e995-e1003.

Research output: Contribution to journalArticle

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