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Clinical Trial
. 2014:2014:463767.
doi: 10.1155/2014/463767. Epub 2014 May 29.

Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome

Wen-Chi Chen  1 , Yan-Hua Chen  2 , Ping-I Hsu  3 , Feng-Woei Tsay  4 , Hoi-Hung Chan  3 , Jin-Shiung Cheng  2 , Kwok-Hung Lai  3
Affiliations
Clinical Trial

Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome

Wen-Chi Chen et al. Biomed Res Int. 2014.

Abstract

Background: Warfarin reduces the incidence of thromboembolism but increases the risk of gastrointestinal bleeding (GIB). GIB during warfarin anticoagulation is rarely evaluated in Asian patients.

Aims: This study aimed at investigating the incidence, risk factors, management, and outcome of GIB in Taiwanese patients treated with warfarin.

Methods: We analyzed a cohort of warfarin anticoagulated patients between July 1993 and May 2012. Clinical data were retrieved in a chart-reviewing manner.

Results: A total of 401 warfarin anticoagulated patients were enrolled. The incidence of GIB was 3.9% per patient-years. Multivariate analysis with Cox regression showed that age >65 years old (RR: 2.5, 95% CI: 1.2-5.5), a mean international normalized ratio >2.1 (RR: 2.1, 95% CI: 1.0-4.2), a history of GIB (RR: 5.1, 95% CI: 1.9-13.5), and cirrhosis (RR: 6.9, 95% CI: 2.0-24.5) were independent factors predicting GIB. 27.3% of the GIB patients had rebleeding after restarting warfarin while thromboembolic events were found in 16.7% of the patients discontinuing warfarin therapy.

Conclusions: Warfarin was associated with a significant incidence of GIB in Taiwanese patients. The intensity of anticoagulation should be monitored closely during warfarin therapy, especially in patients with risk factors of GIB.

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