P0728 - Management of DOACs After Upper Endoscopy for Upper Gastrointestinal Bleeding

Kush M. Patel, MD, Don Rockey, MD
Medical University of South Carolina, Charleston, SC

Introduction: Direct oral anticoagulants (DOAC) are frequently used to treat and prevent thromboembolic diseases. While guidelines exist on the management of DOACs prior to endoscopic interventions for gastrointestinal (GI) bleeding, there is little information available about reinitiating DOACs after such interventions.

Methods: This retrospective cohort study of patients admitted to an academic tertiary referral hospital system with upper GI bleeding (UGIB) who were on a DOAC and who underwent upper endoscopy (EGD) examined data from 2010 to 2023. Patients were identified via the institutions Clinical Data Warehouse using ICD-9/10 codes for each diagnosis and procedure. Outcomes of interest were rates of rebleeding and death in patients who did or did not restart their DOAC after endoscopy. Complete demographic and clinical data were abstracted and entered into a RedCap database.

Results: The cohort included 48 patients with a mean age of 70 (Table 1). The most common indication for DOAC therapy was atrial fibrillation/flutter (65%), and the most prescribed DOAC was apixaban (81%). The most common cause of UGIB was peptic ulcer disease (31%). Four patients underwent repeat endoscopy an average of 5 days after initial endoscopy for rebleeding or acute worsening of anemia. On average, the last dose of DOAC was 64 hours prior to endoscopy. Thirty-seven (77%) patients had their DOAC restarted after endoscopy. The average time to restarting DOAC therapy after endoscopy was 43 hours. Most patients who were not restarted had severe bleeding (defined as a drop in Hgb > 2 gm/dL or requiring blood transfusion). Within 45 days, 4 patients rebled an average of 19 days after EGD, and all were patients who restarted their DOAC. Thus, 4/37 patients who restarted their DOAC and 0/11 patients who did not restart their DOAC rebled (p = 0.55). For 3 that rebled, blood transfusion was required. Five patients died within 45 days (2/37 restarting DOAC, 3/11 not restarting DOAC [p=0.04]), and the average time to death was 19 days. Only 1 patient had both a rebleeding event and died during the follow up period, and the cause of death was unrelated to UGIB.

Discussion: We found that DOACs are commonly restarted after UGIB. Restarting DOAC therapy was not associated with an increased risk of rebleeding, and patients not restarting their DOAC appeared to have increased mortality. Optimal timing for reinitiating anticoagulation after a gastrointestinal bleed warrants further investigation.


Disclosures:


Kush M. Patel, MD, Don Rockey, MD. P0728 - Management of DOACs After Upper Endoscopy for Upper Gastrointestinal Bleeding, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.