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Pálinkás D, Teutsch B, Gagyi EB, Engh MA, Kalló P, Veres DS, Földvári-Nagy L, Hosszúfalusi N, Hegyi P, Erőss B. No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:biomedicines11020554. [PMID: 36831090 PMCID: PMC9953612 DOI: 10.3390/biomedicines11020554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND There are recommendations for anticoagulation resumption after gastrointestinal bleeding (GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated patients is lacking. We aim to determine the safety and efficacy of restarting DOACs after GIB. METHODS Studies that reported rebleeding, thromboembolic events, and mortality after restarting or withholding DOACs were selected. The systematic research was conducted in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Scopus). The random effect model was implemented to calculate the pooled odds ratio (OR). The ROBINS-I tool was used for risk of bias assessment, and the certainty of the evidence was evaluated with the GRADE approach. RESULTS Four retrospective cohort studies (1722 patients) were included in the meta-analysis. We did not find a significant increase in the risk of rebleeding in patients restarting DOACs after index GIB (OR = 1.12; 95% CI: 0.74-1.68). The outcomes of thromboembolic events and mortality data were not suitable for meta-analytic calculations. Single studies did not show statistically significant differences. Data quality assessment showed a serious overall risk of bias and very low quality of evidence (GRADE D). CONCLUSION DOAC resumption after a GIB episode may not elevate the risk of rebleeding. However, the need for high-quality randomized clinical trials is crucial.
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Affiliation(s)
- Dániel Pálinkás
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Department of Gastroenterology, Military Hospital—State Health Centre, H-1134 Budapest, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, H-7622 Pécs, Hungary
| | - Endre Botond Gagyi
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, H-1085 Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
| | - Patrícia Kalló
- Institute for Translational Medicine, Medical School, University of Pécs, H-7622 Pécs, Hungary
| | - Dániel S. Veres
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, H-1094 Budapest, Hungary
| | - László Földvári-Nagy
- Department of Morphology and Physiology, Faculty of Health Science, Semmelweis University, H-1088 Budapest, Hungary
| | - Nóra Hosszúfalusi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, H-7622 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, H-1085 Budapest, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, H-1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, H-7622 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, H-1085 Budapest, Hungary
- Correspondence: ; Tel.: +(36)-30-8874028
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Safety and Efficacy of Sedation During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis. Dig Dis Sci 2022; 68:1426-1434. [PMID: 36272038 PMCID: PMC10102050 DOI: 10.1007/s10620-022-07740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to compare patients with and without sedation during emergency endoscopy for upper gastrointestinal bleeding (UGIB) and to clarify the safety and efficacy of sedation in emergency endoscopy. METHODS We retrospectively collected 389 patients who underwent emergency endoscopy for UGIB at Ureshino Medical Center from 2016 to 2021. Patients were divided into two groups: sedation group during emergency endoscopy and nonsedation group. Clinical characteristics, patient status on admission, and UGIB etiology were evaluated. Treatment outcomes and adverse events were evaluated using propensity score matching (PSM), and risk factors for mortality from UGIB were investigated using Cox multivariate analysis. RESULTS The sedation group was significantly younger, composed of a higher proportion of males, and had chronic liver disease. Blood pressure and hemoglobin level on admission were significantly higher in the sedation group. The main cause of bleeding was peptic ulcer, which was significantly higher in the nonsedation group. PSM created 133 matched pairs. The success rate of endoscopic hemostasis was similar in both groups, and procedure time was significantly shorter in the sedation group than in the nonsedation group (17.6 ± 10.0 versus 20.2 ± 10.2 min, P = 0.04). There were no significant differences in adverse events between groups. Cox multivariate analyses revealed that red blood cell transfusion [hazard ratio (HR) 4.45, P < 0.02] and rebleeding (HR 3.30, P = 0.03) were associated with increased risk of 30-day mortality from UGIB. CONCLUSIONS Sedation reduced the procedure time during emergency endoscopy for UGIB. Sedation during emergency endoscopy for UGIB is acceptable for safe endoscopic procedures.
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