Arrhythmias and Conduction DisturbancesRestarting Anticoagulation and Outcomes After Major Gastrointestinal Bleeding in Atrial Fibrillation
Section snippets
Methods
This is a retrospective cohort study that evaluated the patients enrolled at the anticoagulation clinic of Henry Ford Health System with a large catchment area serving all socioeconomic strata, covering majority of Southeast Michigan, United States. Patients who developed major GIB (defined in the following) while taking warfarin and then had evidence of resolution of major GIB (defined as stability of hemoglobin levels with <1 g decrease of hemoglobin for 48 hours) were included in the study.
Results
Overall, 1,329 patients (mean age 75 ± 11 years, women 47%) developed GIB during January 2005 to December 2010. There were 653 patients (49%) who were restarted on warfarin after a median duration of 50 days (interquartile range 21 to 78). The median CHADS2 and HAS-BLED scores were 3. Endoscopic evaluation was performed in 883 cases (66.4%). Chronic AF was present in 751 (52.6%), persistent AF in 345 (25.9%), and paroxysmal AF in 233 patients (17.5%). Caucasians, patients with concomitant upper
Discussion
This study provides incidences of thromboembolism, mortality, and recurrent GIB in patients who developed GIB while on anticoagulation for nonvalvular AF. The study also demonstrated that lower risks of thromboembolism and mortality were associated with resuming anticoagulation. There were also no significant differences in risk of GIB between resuming warfarin after 1 week of interruption of warfarin compared with restarting warfarin after 1 month; however, risk of recurrent GIB was
Disclosures
The authors have no conflicts of interest to disclose.
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The authors acknowledge the support from the Department of Internal Medicine of Henry Ford Health System for providing funding for administrative data collection.
See page 667 for disclosure information.