Effects of anticoagulation on diverticular bleeding – a retrospective review of 213 cases

Aims To describe a cohort of diverticular bleeding patients and analyse the effects of anticoagulation on different clinical outcomes.

Methods This was a retrospective cohort study, that included diverticular bleeding patients from two Hungarian centres. All adult patients admitted between October 2017 and April 2024 with diverticular bleeding were included. Data was collected on general patient characteristics, admission status, laboratory values, comorbidities, regular medications, including anticoagulants, endoscopy results and bleeding severity. Hemodynamic instability was defined as on-admission systolic blood pressure<100 mmHg, pulse>100/min or syncope. Severe bleeding was defined as bleeding requiring≥2 units of blood transfusion, bleeding requiring intensive care, in hospital rebleeding or readmission within 7 days. Categoric variables are shown as percentages of cases, while continuous variables are presented as mean±standard deviation (SD). We measured the effect of anticoagulation using Student’s T test on the length of hospitalisation (LoH) and using χ² test on the rate of developing severe bleeding, 30-day rebleeding and need for red blood cell (RBC) transfusions. A p<0.05 was considered statistically significant.

Results 213 patients were included in the analysis. Mean age was 78.3±0.75 and 61% of patients were female. 39.9% and 41.3% of patients were using antiplatelets and anticoagulants respectively. On-admission mean Oakland score was 19.4±0.5. 28.6% of patients were hemodynamically unstable on presentation, while 59.6% of cases were considered severe bleeding. Endoscopy was carried out in only 77,5% of cases. LoH was 8.29±0.4 days for the whole cohort. 47.0% of patients required RBC transfusion and 30-day rebleeding rate was 10.3%. Patients on anticoagulants required longer LoH (9.49±0.6 vs 7.18±0.5 days; p=0.003) compared to non-anticoagulated patients. There was no difference between the two groups in the rate of severe bleeding (OR 1.44; 95% CI: 0.498 – 2.24; p=0.20), 30-day rebleeding (OR 1.21; 95% CI: 0.497 – 2.93; p=0.68) or RBC transfusion requirement (OR 1.33; 95% CI: 0.771 – 2.30; p=0.30).

Conclusions Diverticular disease affects an elderly population, where many different comorbidities and medications can contribute to developing severe bleeding. Anticoagulant medication did lengthen time of hospitalisation; however, it did not significantly worsen other clinical outcomes in diverticular bleeding.

Publication History

Article published online:
27 March 2025