Mid-Gastrointestinal Bleeding in Patients Treated With Direct Oral Anticoagulants: a “New” Threat On Capsule Endoscopy?

Aims Direct oral anticoagulants (DOACs) have recently become a widespread alternative in anticoagulant therapy. Nevertheless, concerns are raised about their safety, with increased gastrointestinal bleeding rates being described for these agents when compared to classic anticoagulants. There are few studies regarding the effect of DOACs on small bowel capsule endoscopy (SBCE) findings. We aimed to assess if the detection rate of lesions with high bleeding potential (P2 lesions according to Saurin classification) on SBCE was significantly different in patients treated with DOACs when compared to non-anticoagulated patients and to patients anticoagulated with other agents (low molecular weight heparin and warfarin).

Methods Single center study of consecutive patients who underwent SBCE for suspected mid-gastrointestinal bleeding (MGIB) from January 2019 to October 2020.

Results From 148 patients, 38 (25.7 %) were under anticoagulant treatment, of which 26 (68.4 %) with DOACs. P2 lesions were detected in 36.5 % (n = 54) of the patients submitted to SBCE for suspected MGIB. These lesions were more frequently detected in patients under DOACs treatment when compared to non-anticoagulated patients (69.2 % vs 29.5 %; p < 0.01), but also when compared with patients treated with other anticoagulants (69.2 % vs 33.3 %; p = 0.04).

No differences in the incidence of P2 lesions was observed between patients treated with other anticoagulants and patients with no anticoagulation (33.3 % vs 36.8 %; p = 0.540).

Finally, in multivariate analysis, NOACs usage was significantly associated with higher detection rates of P2 lesions on SBCE, when adjusted for other classical risk factors for MGIB (OR:3.45; IC95 %=1.25-9.52; p = 0.02).

Conclusions Despite their undeniable cardiovascular benefits and easy applicability, DOACs should still be considered with caution when starting anticoagulation therapy. These drugs were significantly associated with higher risk of potentially bleeding lesions on SBCE when compared with other anticoagulants and represent an independent risk factor for MGIB when adjusted for other variables.

Citation: Macedo Silva V, Freitas M, Arieira C et al. eP95 MID-GASTROINTESTINAL BLEEDING IN PATIENTS TREATED WITH DIRECT ORAL ANTICOAGULANTS: A “NEW” THREAT ON CAPSULE ENDOSCOPY? Endoscopy 2021; 53: S127.

Publication History

Article published online:
19 March 2021