Abstract Number: PB2359
Meeting: ISTH 2020 Congress
Background: The risk of upper gastrointestinal (GI) bleeding in patients taking anticoagulation is well documented. Ray et al (2018) estimated that 1% to 1.5% of patients on oral anticoagulants will experience upper GI bleeds every year, and anticoagulant choice and PPI co-therapy could affect the risk of upper GI tract bleeding. For patients on Proton Pump Inhibitor (PPI) had a reduced overall bleeding across all anticoagulants, for an incidence rate ratio of 0.66 and a risk reduction of 34%.
Aims: To review risks of upper GI bleeding whilst on anticoagulation.
Methods: In Barnet District General Hospital there are 7700 patients on anticoagulation and are under the care of the anticoagulation clinic. We undertook a retrospective study from Sept 2018 to May 2019 to look at the number of patients presenting with an upper GI bleed.
Results: Between September 2018 and May 2019, 153 patients presented with an upper GI bleed of those only 17 patients were on anticoagulation (this includes 4 on warfarin and 11 on DOAC therapy). Of those patients who developed bleeds all were older than 80 apart from one who was 69 years old. This equates to 0.2% of patients on anticoagulation at Barnet Hospital presenting with upper GI bleeds during this period.
Conclusions: A factor that may explain the reduced incidence of bleeding whilst on anticoagulation is the involvement of the Barnet anticoagulation clinic. The clinic assesses and educates all patients on anticoagulation. This includes selecting out high risk patients and modifying risk factors such as ensuring PPI cover. Additionally, the anticoagulation clinic at Barnet, has the highest Time in Therapeutic Range (TTR) benchmarked nationally.
Though trial data shows an increased incidence of GI bleeds whilst on anticoagulation, this audit suggests that the role of an anticoagulation clinic could be significant in decreasing the incidence of bleeding events.
To cite this abstract in AMA style:Al-Hassani A, Packham B, Ang KM, Patel R. Can an Effective anticoagulation Clinic Reduce Bleeding Risks? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/can-an-effective-anticoagulation-clinic-reduce-bleeding-risks/. Accessed January 28, 2022.
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