Impact of anticoagulation on upper-gastrointestinal-bleeding in cirrhosis. a retrospective multicenter study.
Hepatology. 2015 Mar 12;
Authors: Cerini F, Martínez Gonzalez J, Torres F, Puente Á, Casas M, Vinaixa C, Berenguer M, Ardevol A, Augustin S, Llop E, Senosiaín M, Villanueva C, de la Peña J, Bañares R, Genescá J, Sopeña J, Albillos A, Bosch J, Hernández-Gea V, Garcia-Pagán JC
Abstract
BACKGROUND AND AIM: Recent studies have shown that liver cirrhosis (LC) behaves as an acquired hypercoagulable state with increased thrombotic risk. This is why anticoagulation therapy (AT) is now frequently used in these patients. Variceal bleeding is a severe complication of LC. It is unknown if AT may impact the outcome of bleeding in these patients.
METHODS: 52 patients on AT with upper gastrointestinal bleeding (UGIB) were evaluated. Portal vein thrombosis (PVT) and different cardiovascular disorders (CVD) were the indication for AT in 14 and 38 pts respectively. 104 patients with LC and UGIB not under AT matched for severity of LC, age, sex, source of bleeding and SOFA score, served as controls.
RESULTS: UGIB was attributed to portal hypertension (PH) in 99 (63%) patients and peptic/vascular lesions in 57 (37%). 26 (17%) patients experienced 5-day-failure; SOFA, source of UGIB and PVT, but not AT were independent predictors of 5-day failure. In addition, independent predictors of 6-weeks-mortality, that was observed in 26 (11%) patients, were SOFA, Charlson Comorbidity index and the use of AT for a CVD. There were no differences between pts with/without AT in needs for rescue therapies, ICU admission, transfusions and hospital stay.
CONCLUSIONS: Our study suggests that factors that impact the outcome of UGIB in patients under AT are the degree of multi-organ failure and comorbidity, but not AT itself. This article is protected by copyright. All rights reserved.
PMID: 25773591 [PubMed - as supplied by publisher]