D0300 - Relationship of Decrease in Hemoglobin on Initial Monitoring to the Incidence of Major Gastrointestinal Bleeding

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 and managing major gastrointestinal bleeding and preventing hospitalization are important to reduce health care costs and improve patient care. Hemoglobin (Hgb) is used to monitor anemia and bleeding in patients on anticoagulation therapy. The utility of Hgb monitoring after initiation of apixaban has not been confirmed.

Methods: We retrospectively identified veterans at the Dayton VAMC who were started on apixaban between 2013 and 2020. Demographics, HASBLED Score, Hgb within 3 months of initiation of apixaban, and a subsequent Hgb were recorded. Two groups were formed: decrease in Hgb < 2 gm/dL and ≥2 gm/dL. We compared the two groups on incidence of gastrointestinal bleeding . Also, we evaluated if patients with a ≥2 gm/dL Hgb decrease were referred to gastroenterology.

Results: There were 1397 veterans initiated on apixaban with baseline and subsequent screening Hgb, 1343 (96%) in the < 2 gm/dL group and 54 (4%) in the ≥2 gm/dL group. The two groups did not differ on age, sex, or race. The mean HASBLED Score at initiation of apixaban therapy was 2.24±1.08 and 2.44±1.09 (p=0.19), respectively. There were 41 major gastrointestinal bleeds (2.93%). The incidence of major gastrointestinal bleeding was 2.2% in the < 2 gm/dL group and 20.4% in the ≥2 gm/dL group (p< 0.001). Of patients with a ≥2 gm/dL decrease, 27.8% had a gastroenterology referral placed.

Discussion: Hemoglobin is frequently used as a screening tool to evaluate patients on anticoagulation therapy for anemia and potential bleeding. There are no current guidelines to assist with decision-making based on degree of hemoglobin decrease. We found an increased incidence of major gastrointestinal bleeding in patients with a ≥2 gm/dL decrease in Hgb from apixaban initiation to follow-up assessment. Given the increased risk for gastrointestinal bleeding in the ≥2gm/dL decrease group, the low percent (28%) of these patients receiving a gastroenterology referral indicates need for improvements to enhance patient care and lower hospitalizations. This study was limited by its retrospective design and predominantly male patient population, but the sample size was large. Future prospective studies should assess if immediate referral to gastroenterology after a notable decrease in hemoglobin results in a lower rate of hospitalization for gastrointestinal hemorrhage and decreased cost.



Disclosures:


Chris Casaccio, DO¹, Ammar Ahmad, MD², Amanda Peck, ², Ronald Markert, PhD², Padmini Krishnamurthy, MD³. D0300 - Relationship of Decrease in Hemoglobin on Initial Monitoring to the Incidence of Major Gastrointestinal Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.