Background: Gastrointestinal (GI) bleeding is a well described complication in patients anticoagulated for venous thromboembolism (VTE) with and without malignancy. Little data exists on endoscopic evaluation, management, and outcomes in this population.
Aims: To describe the endoscopic evaluation strategies, findings, and management in patients with GI bleeding receiving anticoagulation therapy for VTE.
Methods: Review of medical records of 3287 consecutive, anticoagulated patients enrolled in the Mayo Clinic VTE Registry between March 2013 through October 2021 that experienced GI major (MB) or clinically relevant non major bleeding (CRNMB).
Results: Three percent (109 patients, mean age 67, range 26-100, 52.3% female) had GI bleeding while on anticoagulation, 62 (56.9%) MB and 47 (43.1%) CRNMB. Cancer was present in 76 (69.7%), 22 (20.2%) from the GI tract (Table 1). In 18 patients bleeding was managed outpatient. Transfusion was needed in 62 patients (56.9%). Endoscopic evaluation was completed in 72 (66.1%): upper endoscopy in 51, lower in 40, and capsule in 2 patients. A bleeding source was identified with endoscopy in 49 (44.5%) patients and an endoscopic procedure to address active bleeding was performed in 19 (26.4%) (Table 2). Therapeutic anticoagulation was held in 90 patients (82.6%) for a mean of 3 days (range 0-116). For 21 patients, anticoagulation was reduced to a prophylactic dose temporarily and in 4 permanently. Anticoagulation was indefinitely discontinued in 30 cases (27.5%). During follow up 56 (51.4%) of the patients died, and 20 (18.3%) had a recurrent MB or CRNMB, 16 of them from the GI tract.
Conclusion(s): Two thirds of patients with GI bleeding undergo endoscopic evaluation but a bleeding source is identified in only half of those cases, and only a fifth are amenable for treatment. GI bleeding is a significant cause of anticoagulation discontinuation
To cite this abstract in AMA style:Brunton N, Wysokinski W, Vlazny D, Hodge D, Siddiqui H, Houghton D, Casanegra A. Endoscopic Evaluation in Patients with Gastrointestinal Bleeding Receiving Anticoagulation for Venous Thromboembolism [abstract]. https://abstracts.isth.org/abstract/endoscopic-evaluation-in-patients-with-gastrointestinal-bleeding-receiving-anticoagulation-for-venous-thromboembolism/. Accessed September 24, 2023.
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