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Thirty-day mortality in atrial fibrillation patients with gastrointestinal bleeding in the emergency department: differences between direct oral anticoagulant and warfarin users

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Abstract

More clinical data are required on the safety of direct oral anticoagulants (DOACs). Although patients treated with warfarin and DOACs have a similar risk of bleeding, short-term mortality after a gastrointestinal bleeding (GIB) episode in DOAC-treated patients has not been clarified. The objective of this study was to assess differences in 30-day mortality in patients treated with DOACs or warfarin admitted to the emergency department (ED) for GIB. This was a multicentre retrospective study conducted over 2 years. The study included patients evaluated at three different EDs for GIB. The baseline characteristics were included. Subsequently, we assessed the differences in past medical history and clinical data between the two study groups (DOAC and warfarin users). Differences between the two groups were evaluated using Kaplan–Meier curves. Among the 284 patients presenting GIB enrolled in the study period, 39.4% (112/284) were treated with DOACs and 60.6% (172/284) were treated with warfarin. Overall, 8.1% (23/284) of patients died within 30 days. Among the 172 warfarin-treated patients, 8.7% (15/172) died within 30 days from ED evaluation. In the 112 DOAC-treated patients, the mortality rate was 7.1% (8/112). The Cox regression analysis, adjusted for possible clinical confounders, and the Kaplan–Meier curves did not outline differences between the two treatment groups. The present study shows no differences between DOACs and warfarin in short-term mortality after GIB.

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Authors and Affiliations

  1. Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria Dell’Alto Adige, Merano, Bolzano, Italy

    Gianni Turcato, Arian Zaboli & Norbert Pfeifer

  2. Department of Emergency Medicine, University of Verona, Verona, Italy

    Antonio Bonora, Massimo Zannoni & Antonio Maccagnani

  3. Department of Cardiology and Intensive Care Cardiology, Girolamo Fracastoro Hospital of San Bonifacio, Azienda Ospedaliera Scaligera, San Bonifacio, Verona, Italy

    Elisabetta Zorzi & Giorgio Ricci

  4. Department of Emergency Medicine, Girolamo Fracastoro Hospital of San Bonifacio, Azienda Ospedaliera Scaligera, San Bonifacio, Verona, Italy

    Andrea Tenci

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  1. Gianni Turcato
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Correspondence to Gianni Turcato.

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This retrospective study was conducted in accordance with the current rules of the local ethics committee.

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Consent to the study’s participation was requested at their access in the emergency department.

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Turcato, G., Bonora, A., Zorzi, E. et al. Thirty-day mortality in atrial fibrillation patients with gastrointestinal bleeding in the emergency department: differences between direct oral anticoagulant and warfarin users. Intern Emerg Med 15, 311–318 (2020). https://doi.org/10.1007/s11739-019-02229-7

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