Sources of Gastrointestinal Bleeding in Anticoagulated vs. Non-Anticoagulated Patients; A Comparison Study

Aims: To review patients presenting with GI bleeding, comparing bleeding source identified of those patients on warfarin with those who are not.

Methods: Retrospective review of all patients presenting in the last three years with GI bleeding at Midland Regional Hospital, Tullamore, Ireland.

Results: We identified 70 patients with GI bleeding. Thirty four patients were anticoagulated and 36 patients were not. Of the total group bleeding source was identified in 52.8%, 52.9% in anticoagulated group and 52.7% in non-anticoagulated group. Causes of bleeding were similar in both the groups. The commonest cause was peptic ulcer disease (19.0%) followed by gastric cancer (11.3%).In the anticoagulated group, 55.8% of patients were within therapeutic range, 11.7% were under and 32.4% were over-anticoagulated at the time of presentation. The causes of bleeding were similar in both groups. No cause was identified in 47.1% of anticoagulated group and 47.3% of non-anticoagulated group.

Conclusion: In almost half of all patients no cause was identified for GI bleed and where a cause was identified, aetiology was similar in both the groups. Our study suggests that management of both the groups should be similar and we recommend that patients should have a diagnostic endoscopy as soon as possible after presentation as it is likely that the timing of investigations has an impact on the likelihood of identifying a cause.