P2562 - Severity of Gastrointestinal Bleeding in Obese vs. Non-Obese Veterans Taking Direct Oral Anticoagulants

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Ammar Ahmad, MD

Wright State University Boonshoft School of Medicine
TIPP CITY, OH, United States

Ammar Ahmad, MD, Ronald Markert, PhD, Sangeeta Agrawal, MD
Wright State University Boonshoft School of Medicine, Dayton, OH

Introduction: Obesity is a rapidly increasing health problem in the United States. Obesity-related changes in physiology can affect the absorption, distribution, metabolism, and excretion of drugs which can lead to altered clinical response. Direct oral anticoagulants (DOACs) have been available for almost a decade and are recommended over vitamin K antagonist therapy in patients with pulmonary embolism (PE), deep venous thrombosis (DVT), and non-valvular atrial fibrillation. Although their use in obese patients (BMI between 30 and 40 kg/m²) has not shown worse clinical outcomes, the severity of gastrointestinal bleeding, a major adverse effect of anticoagulants, is not well-studied in obese patients. The purpose of this study is to evaluate the severity of gastrointestinal bleeding in obese vs. non-obese veterans taking DOACs.

Methods: We retrospectively evaluated electronic medical records of veterans who were admitted for gastrointestinal bleeding while taking a DOACs (Dabigatran, Apixaban, Rivaroxaban, & Edoxaban) between 2010 and 2020. Outcomes included drop in hemoglobin compared to baseline, number of packed red blood cell (pRBCs) transfusions, intervention required to stop bleeding, hemodynamic instability at presentation, admission to Intensive Care Unit (ICU), duration of hospitalization, and 30-day rebleed. SPSS was used for chi-square testing at alpha of 0.05.

Results: In total, 63 veterans had gastrointestinal bleeding while taking DOACs. Out of these 63 veterans, 41 were taking apixaban, 18 were taking rivaroxaban, and 4 were taking dabigatran. 26 of them were obese, whereas 37 were not obese. Drop in hemoglobin compared to baseline, pRBCs transfused, intervention required to stop bleeding, hemodynamic instability at presentation, admission to Intensive Care Unit (ICU), duration of hospitalization, and 30-day rebleed rate were all lower in obese patients compared to non-obese patients but were not statistically significant (Table 1).

Discussion: Although obesity can affect pharmacokinetics and pharmacodynamics of drugs, our study did not show any statistical difference in the severity of gastrointestinal bleeding in obese vs. non-obese patients taking DOACs. The major limitation of our study is a smaller sample size. Studies with larger sample size need to be performed to evaluate further.

	Non-Obese (N = 37)	Obese (N = 26)	p
Sex
Male	37 (100%)	26 (100%)
Female	0 (0%)	0 (0%)
Age (Mean ± St. Deviation)	74.5 ± 8.85	72.6 ± 9.25	0.54
Race
Caucasian	36 (97.3%)	25 (96.2%)	1.0
African American	1 (2.7%)	1 (3.8%)	1.0
Charlson Comorbidity Index (Mean ± St. Dev)	6.78 ± 2.86	6.81 ± 2.21	0.87
Concomitant aspirin use	23 (62.2%)	19 (73.1)	0.37
Concomitant clopidogrel use	9 (24.3%)	4 (15.4%)	0.39
Outcomes
Drop in HgB (g/dl) – (Mean ± St. Dev)	4.23 ± 1.90	3.88 ± 1.83	0.46
No. of pRBCs transfused (Mean ± St. Dev)	1.22 ± 1.29	1.12 ± 1.21	0.79
Intervention required to stop bleeding	19 (51.4%)	8 (30.8%)	0.10
Hemodynamically unstable at presentation	3 (8.1%)	2 (7.7%)	1.0
Admitted to ICU	6 (16.2%)	1 (3.8%)	0.12
Duration of Hospitalization (Days) – (Mean ± St. Dev)	4.03 ± 2.09	3.54 ± 2.28	0.28
30-Day rebleed Cases (%)	3 (8.1%)	1 (3.8%)	0.87

Table: Table 1: Characteristics of gastrointestinal bleeding in obese vs. non-obese veterans taking DOACs.

Disclosures:

Ammar Ahmad indicated no relevant financial relationships.

Ronald Markert indicated no relevant financial relationships.

Sangeeta Agrawal indicated no relevant financial relationships.

Ammar Ahmad, MD, Ronald Markert, PhD, Sangeeta Agrawal, MD. P2562 - Severity of Gastrointestinal Bleeding in Obese vs. Non-Obese Veterans Taking Direct Oral Anticoagulants, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.