Comparison of the effect of warfarin and direct oral anticoagulants in upper gastrointestinal system bleeding

Objective: In this study, it was aimed to compare the frequency of new oral anticoagulants and warfarin usage, and to reveal the rates of recurrent upper gastrointestinal bleeding among patients who applied to our hospital with upper gastrointestinal bleeding . Materials-Methods: 346 patients who were admitted to Samsun Training and Research Hospital with a diagnosis of upper gastrointestinal bleeding and hospitalized by Internal Medicine and Gastroenterology clinics or who underwent outpatient endoscopy between 01.01.2021 and 31.12.2021 were included in the study. The patients' data were analyzed from the patient files and hospital automation system retrospectively. Patients who had recurrent upper GI bleeding were detected by controlling them over the hospital software system and by reaching each patient again. The frequency of use of new generation oral anticoagulants in patients with rebleeding was determined, and data such as rebleeding rate, length of hospital stay, need for transfusion, and mortality were analyzed in the groups who did not use this drug and those who used it. Patients using new generation oral anticoagulants were also compared with patient groups using acetylsalicylic acid and using warfarin. Results: 346 patients were included in the study. Of these patients, 151 (43.6%) were female, 195 (56.4%) were male, and the mean age was 68.8 ± 15.8 years. When we investigated the usage of drugs that may cause bleeding risk, the results were as follows: 102 (29.5%) acetyl salicylic acid, 58 (16.8%) clopidogrel, 19 (5.5%) warfarin and 65 (18.8%) patients were using new generation oral anticoagulants, 107 (30.9%) were using nonsteroidal anti-inflammatory drugs. When the frequency drug usage that cause bleeding risk was compared according to the recurrent bleeding status, the frequency of drug use was found to be statistically similar between the two groups. When compared according to mortality status, the frequency of drug use was found to be statistically similar between the two groups. Conclusion: There was no significant difference in the frequency of recurrent upper gastrointestinal bleeding between patients using warfarin and new generation oral anticoagulants. When the patients were divided into two groups according to the incidence of recurrent gastrointestinal bleeding and compared in terms of age, gender, comorbidities that may cause bleeding, drug use, and mortality, there was no statistically significant difference between the two groups. More comprehensive studies are needed on this subject. Keywords: Gastrointestinal system, oral anticoagulant, rebleeding