C0325 - Incidence of Major Gastrointestinal Bleeding for Early vs Late Hemoglobin Monitoring in Veterans Taking Apixaban

Chris Casaccio, DO¹, Ammar Ahmad, MD², Amanda Peck, ², Ronald Markert, PhD², Padmini Krishnamurthy, MD^3
1Wright State University Boonshoft School of Medicine/Wright Patterson AFB, Columbus, OH; ²Wright State University Boonshoft School of Medicine, Dayton, OH; ³Dayton VA Medical Center, Dayton, OH

Introduction: Gastrointestinal bleeding is a major cause of hospital-associated mortality and financial burden on the health care system. Identifying gastrointestinal bleeding and preventing hospitalization are important goals. Hemoglobin (Hgb) levels are used to screen for anemia and bleeding in patients on anticoagulation therapy. Studies of warfarin did not find prevention of gastrointestinal bleeding with Hgb monitoring. Apixaban therapy does not require monitoring of INR as frequently as warfarin. We compared the incidence of major gastrointestinal bleeding between patients who had early Hgb monitoring (≤90 days) versus late Hgb monitoring ( >90 days) after initiation of apixaban therapy.

Methods: We retrospectively identified veterans at Dayton VAMC who were started on apixaban between 2013 and 2020. Demographics, HASBLED Score at apixaban initiation, duration of anticoagulation use, and days between apixaban initiation and subsequent Hgb check were obtained. Outcome was incidence of major gastrointestinal bleeding.

Results: In total, 1840 veterans initiated on apixaban had a subsequent screening Hgb level. Most patients 1376 (75%) had Hgb screening within 90 days while 464 (25%) had Hgb screening after more than 90 days. Early and late Hgb monitoring groups did not differ on age, sex, and race. The mean HASBLED Score was 2.27±1.08 and 2.13±1.02 in early versus late groups (p=0.022). The mean duration of apixaban use in months was 21.3±16.1 in the early group and 31.0±20.1 in late group (p< 0.001). There were 43 major gastrointestinal bleeds (2.3%). The incidence of major gastrointestinal bleeding was greater in the early group than in the late group (2.9% vs. 0.6%, p=0.005).

Discussion: We found more major gastrointestinal bleeding for early Hgb monitoring. Demographics did not differ and the higher mean HASBLED Score for early monitoring was not clinically meaningful. The 10-month longer duration of apixaban use in the late monitoring group could imply that earlier monitoring may lead to discontinuation of anticoagulation without prevention of major gastrointestinal bleeding. This study was limited by its retrospective design and predominantly male patient population, but the sample size was large. Prospective studies would better assess the utility of Hgb monitoring and whether other measures in combination can prevent hospitalization for gastrointestinal bleeding. Further, the value of early and frequent Hgb monitoring in relation to discontinuation of anticoagulation should be evaluated.



Disclosures:


Chris Casaccio, DO¹, Ammar Ahmad, MD², Amanda Peck, ², Ronald Markert, PhD², Padmini Krishnamurthy, MD³. C0325 - Incidence of Major Gastrointestinal Bleeding for Early vs Late Hemoglobin Monitoring in Veterans Taking Apixaban, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.