Background: Patients on systemic anticoagulation are at increased risk for gastrointestinal bleeding (GIB). Guidelines recommend endoscopy within 24 hours for diagnostic and therapeutic purposes. Unfortunately, lack of resources and/or gastroenterologists in small, community centers limit the ability to perform timely endoscopy. Conservative management is used in this setting with delayed or outpatient endoscopy, specifically in those who respond to medical therapy. There is minimal data on the outcomes of patients managed in this fashion.
Objective: To compare outcomes of patients on systemic anticoagulation who present with non-variceal upper GIB in a small community hospital.
Design: We conducted a retrospective cohort chart review.
Participants: 115 adult patients who met the inclusion criteria for non-variceal upper GIB on systemic anticoagulation. Excluded patients were those on dual antiplatelet therapy, history of decompensated cirrhosis, variceal bleeds, active GIB identified on imaging (defined as contrast extravasation on CT angiogram or positive tagged RBC nuclear scan), and those with gastrointestinal malignancy.
Interventions: Resuscitative medical therapy (MT) alone vs inpatient endoscopy with resuscitative MT.
Main Measures: Outcomes included red blood cell (RBC) transfusions, re-admission for GIB, and 30-day all-cause mortality. Sub-group analysis was also performed based on endoscopy timeline and anticoagulation type.
Key Results: Patient in MT group required less RBC transfusions compared to endoscopy group (1.4 vs 2.5 average units, [95% CI 1.01-1.87]; P=0.004). There was no statistical significance for re-admission for gastrointestinal bleeding or mortality between both groups. Moreover, there was no significant difference in RBC transfusions based on EGD timing. Most patients were on warfarin (n=47) and there were no differences in re-admission for GIB or mortality based on anticoagulant use.
Conclusion: Our study suggests that there is no significant therapeutic benefits to inpatient endoscopy in comparison to medical management alone in anticoagulated patients who present with non-variceal UGIB.