OC 34.3 - Major gastrointestinal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: a score to identify high risk patients

Monday, July 11, 2022

11:15 AM – 11:30 AM

Location: ExCel Center, ICC Capital Suite Room 14-16

Presentation Format: In-Person

Presenting Author(s)

Judith CATELLA, MD

Hospices Civils de Lyon
LYON, Rhone-Alpes, France

Co-Author(s)

Laurent Bertoletti, MD, PhD

MD, PhD
Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne ; INSERM CIC 1408 CHU de St-Etienne; INSERM UMR 1059, Université Jean Monnet, Saint-Etienne ; FCRIN INNOVTE, France.
Saint-Etienne, Rhone-Alpes, France
FM

Farès Moustapha

MD PhD
CHU Clermont Ferrand
Clermont Ferrand, Auvergne, France
JN

Jose Antonio Nieto

MD
Hospital General Virgen de la Luz
Cuenca., Andalucia, Spain
RV

Reina Valle

MD
Hospital Sierrallana
Santander, Andalucia, Spain
jP

jose Maria Pedrajas

MD
Hospital Clínico San Carlos
Madrid, Andalucia, Spain
AV

Aurora Villalobos

MD
Hospital Regional Universitario de Málaga
Málaga, Andalucia, Spain
IQ

Isabelle Quere

MD PhD
Hopital St Eloi
montpellier, Provence-Alpes-Cote d'Azur, France
GS

Gabrielle Sarlon

MD PhD
Hopital la Timone
Marseille, Provence-Alpes-Cote d'Azur, France
MM

Manuel Monreal

MD PhD
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
Barcelona, Andalucia, Spain

Background: The gastrointestinal (GI) tract is a frequent site of bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE).

Aims: We tried to identify at-risk patients.

Methods: We used the RIETE registry to assess the clinical characteristics of patients developing major GI bleeding during the course of anticoagulation. Then, we built a predictive score based on multivariable analysis, aiming to identify patients at increased risk for major GI bleeding.

Results: We included 87,431 patients with acute VTE. During the course of anticoagulation, 778 (0.89%) suffered major GI bleeding, 815 (0.93%) non-major GI bleeding and 1,462 (1.67%) had major bleeding outside the GI tract. During the first 30 days after major GI bleeding, 7.6% of patients re-bled, 3.9% had VTE recurrences and 33% died. On multivariable analysis, male sex, age ≥70 years, initial VTE presentation as pulmonary embolism, active cancer, prior VTE, recent major bleeding in the GI tract, esophageal varicosities, anemia, abnormal prothrombin time, renal insufficiency and use of corticosteroids were associated to an increased risk for major GI bleeding. Using the predictive score, 39,591 patients (45%) were at low risk; 36,602 (42%) at intermediate-risk; 9,315 (11%) at high-risk; and 1,923 (2.2%) at very high risk. Their rates of major GI bleeding were: 0.21%, 0.96%, 2.41% and 6.08%, respectively. The c-statistics was 0.771 (95%CI. 0.755-0.786).

Conclusion(s): Major GI bleeding is a severe complication in patients receiving anticoagulant therapy for VTE. At risk patients may be reliably identified using a number of variables easily available at baseline.