Background: The gastrointestinal (GI) tract is a frequent site of bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE).

Aims: We tried to identify at-risk patients.

Methods: We used the RIETE registry to assess the clinical characteristics of patients developing major GI bleeding during the course of anticoagulation. Then, we built a predictive score based on multivariable analysis, aiming to identify patients at increased risk for major GI bleeding.

Results: We included 87,431 patients with acute VTE. During the course of anticoagulation, 778 (0.89%) suffered major GI bleeding, 815 (0.93%) non-major GI bleeding and 1,462 (1.67%) had major bleeding outside the GI tract. During the first 30 days after major GI bleeding, 7.6% of patients re-bled, 3.9% had VTE recurrences and 33% died. On multivariable analysis, male sex, age ≥70 years, initial VTE presentation as pulmonary embolism, active cancer, prior VTE, recent major bleeding in the GI tract, esophageal varicosities, anemia, abnormal prothrombin time, renal insufficiency and use of corticosteroids were associated to an increased risk for major GI bleeding. Using the predictive score, 39,591 patients (45%) were at low risk; 36,602 (42%) at intermediate-risk; 9,315 (11%) at high-risk; and 1,923 (2.2%) at very high risk. Their rates of major GI bleeding were: 0.21%, 0.96%, 2.41% and 6.08%, respectively. The c-statistics was 0.771 (95%CI. 0.755-0.786).

Conclusion(s): Major GI bleeding is a severe complication in patients receiving anticoagulant therapy for VTE. At risk patients may be reliably identified using a number of variables easily available at baseline.

Figure1

Cumulative incidence of major GI bleeding during the first 365 days of anticoagulation, according to the prognostic score.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/major-gastrointestinal-bleeding-in-patients-receiving-anticoagulant-therapy-for-venous-thromboembolism-a-score-to-identify-high-risk-patients/