Gastrointestinal Bleeding Associated with Anticoagulant and Antiplatelet Therapy

INTRODUCTION Treatment of gastrointestinal bleeding in patients receiving anticoagulant and antiplatelet therapy is an extremely complex and urgent problem. The risks of recurrent bleeding in such patients are extremely high, while the effectiveness of standard methods of treating gastrointestinal bleeding in this category of patients is lower, compared to the general population. The above served as a prerequisite for this study.

MATERIAL AND METHODS In the period from 2020 to 2023, 362 patients receiving antiplatelet or anticoagulant therapy were treated for gastrointestinal bleeding at the O.I. Filatov City Clinical Hospital. All patients underwent endoscopic examination of the gastrointestinal tract, with primary endoscopic hemostasis required in 126 patients (34.8%). Endovascular embolization of the vessel — the source of bleeding. Risk factors for death, need for surgical intervention and recurrence of bleeding were analyzed. The sensitivity and specificity of the Rockall and Glasgow–Blatchford scales for assessing the risk of recurrence of bleeding and the need for surgical intervention in this category of patients were studied.

RESULTS Anticoagulant therapy was statistically significantly associated with an increased risk of death. Among the risk factors for death, COVID-19 infection, age over 75 years, and arterial hypertension were statistically significant. Endovascular hemostasis demonstrated the greatest effectiveness embolization , the frequency of recurrent bleeding in this intervention was 5.7%, versus 32.5% in endoscopic interventions. The prognostic significance of the Rockall and Glasgow– Blatchford scales according to the results of our study was insufficient.

CONCLUSION The results of the study are consistent with the data of the world literature. It is necessary to take into account the high efficiency of endovascular embolization in this category of patients when choosing a hemostasis method. Risk factors associated with a fatal outcome also do not contradict the generally accepted concept. At the same time, the feasibility and objectives of using current prognostic scales in such patients require further study.

Patients over 75 years of age receiving anticoagulant therapy, as well as patients with COVID-19, have a lower risk of death, which must be taken into account when treating such patients (p<0.01).

The appropriateness of using the Rockall and Glasgow–Blatchford prognostic scales in this category of patients is low, as evidenced by the low area under the curve (AUC) for the Rockall scale (0.6) and for the Glasgow–Blatchford scale (0.48).

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