Literature Scan
New and noteworthy research from the
medical literature landscape
Gastrointestinal Bleeding Not Affected by
Resumption of Anticoagulation Therapy
When a patient requiring longterm anticoagulant therapy
experiences gastrointestinal (GI)
bleeding, requiring interruption
of therapy, clinicians must decide
whether or not to resume anticoagulation following that bleed.
Interruption of warfarin following
a GI bleed has also been associated
with an increased risk of death
and thromboembolic events, while
resumption of warfarin may be
associated with an increased risk
of recurrent bleeding.
Chatree Chai-Adisaksopha,
MD, from the Department of
Medicine at McMaster University in Hamilton, Ontario, and
colleagues conducted a literature
review of phase III, randomized,
controlled trials and cohort studies in patients with atrial fibrillation or venous thromboembolism
who received oral anticoagulation
to help answer the question of
whether restarting warfarin after
TABLE 1.
GI bleeding was safe in these
patients.
Through a search of MEDLINE, EMBASE, and CENTRAL
databases, Dr. Chai-Adisaksopha
and co-authors identified three
observational studies conducted
between 1996 and July 2014
(TABLE 1).
Thromboembolic events occurred more often in patients who
stayed off of warfarin, with the
resumption of warfarin leading to
a significant reduction in thromboembolic events (hazard ratio
[HR] = 0.68 [95% CI 0.52-0.88];
p=0.004).
In addition, resuming warfarin therapy was associated with
a significant reduction in patient
mortality (HR=0.76; 95% CI 0.660.88; p<0.001).
The researchers also observed
an increase in recurrent GI bleeding among patients who resumed
warfarin compared with those
who did not,