Cor Vasa 2017, 59(2):e128-e133 | DOI: 10.1016/j.crvasa.2016.03.006

Upper gastrointestinal bleeding in the setting of excessive warfarin anticoagulation: Risk factors, and clinical outcome

Leili Pourafkari^a,b,c, Samad Ghaffari^b, Niloofar Zamani^a, Kourosh Masnadi-Shirazi^b, Nasrin Khaki^b, Arezou Tajlil^b, Ata Hassani Afshar^c, Nader D. Nader^c,*

^a Department of Medicine ,Tabriz Branch, Islamic Azad University Tabriz, Iran

^b Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, 51666, Iran

^c Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY 14214, United States

Aim: Gastrointestinal tract is the most common source of severe bleeding following excessive warfarin anticoagulation (EWA). We aimed to describe the risk factors and outcome associated with upper gastrointestinal bleeding (UGIB) in patients admitted with EWA.

Methods: Demographics, clinical, laboratory and endoscopic findings of patients admitted with EWA from 2003 to 2015 were reviewed. Hospital mortality, blood product utilization and hospital length of stay were recorded. Regression analyses were performed for prediction of GI bleeding and mortality in patients with EWA.

Results: Medical records of 157 women and 121 men were reviewed. From 41 patients presented with UGIB, 31 (75.6%) underwent esophagogastroduodenoscopy. Preexisting peptic ulceration (32.2%) was the most common source of bleeding in these patients. Hospital mortality was 9.8% in patients with UGIB which was similar to those without. In average, patients with UGIB required 2 units more packed red blood cells and fresh frozen plasma. Older age (p = 0.045) and previous history of peptic ulcer disease (p < 0.001) were the predictors of UGIB in patients with EWA.

Conclusion: Presence of past or current peptic disorders was the strongest predictor of UGIB in patients with EWA. Despite comparable hospital mortality, these patients required more transfusion of blood products.

Keywords: Esophagogastroduodenoscopy; Upper gastrointestinal bleeding; Warfarin

Received: January 20, 2016; Accepted: March 30, 2016; Published: April 1, 2017  Show citation