DIRECT ORAL ANTICOAGULANTS IN ACUTE UPPER GI BLEEDING – WHAT IS THE IMPACT ON ENDOSCOPY EFFICIENCY?

Aims Acute upper GI bleeding (AUGIB) is a common medical emergency with 10% mortality. Direct oral anticoagulants (DOACs) are associated with an increased risk of AUGIB but the length of stay, re-bleed risk and mortality following a bleed has not been fully ascertained We aimed to compare the influence of DOACs on factors affecting endoscopy and post-endoscopy outcomes.

Methods Retrospective data collection of all emergency gastroscopies at a London-based endoscopy site between 6/9/2018 and 8/5/2019. Gastroscopies performed for non-AUGIB indications and patients who developed an AUGIB as an inpatient were excluded. An unpaired T- test was applied comparing patients on DOACs vs. those not taking a DOAC. Equal variances were assumed in both groups. A p value of < 0.05 was deemed significant.

Results 131 new admissions for AUGIB were identified during the study period. 18 (13.7%) were taking a DOAC at the time of bleed. Mean age of patients on a DOAC was 83.8 vs. 68.0 in those not taking a DOAC (p < 0.01). Mean admission to scope time in the DOAC cohort was 109.3 vs 34.1 hours when not taking a DOAC (p < 0.009). Patients taking a DOAC showed a trend towards a longer length of stay vs. those not taking a DOAC (1161.2 vs 376.5 hours, p = 0.06).

Conclusions Over 10% of patients admitted with AUGIB were taking a DOAC. AUGIB patients that were taking a DOAC were a significantly older cohort. Taking a DOAC significantly increased the admission to scope time and resulted in a trend towards longer length of stay. Given the more widespread use of DOACs and prevalence in AUGIB patients, separate guidelines on the management of this sub-group may optimise peri-procedural efficiency.