No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection and Data Collection
2.3. Risk of Bias Assessment
2.4. Data Synthesis and Statistical Analysis
2.5. Quality of Evidence
3. Results
3.1. Search and Selection
3.2. Basic Characteristics of Included Studies
3.3. Gastrointestinal Rebleeding
3.4. Thromboembolic Event
3.5. All-Cause Mortality
3.6. Risk of Bias Assessment
3.7. Quality of Evidence
4. Discussion
4.1. Recurrent Gastrointestinal Bleeding
4.2. Thromboembolic Complications
4.3. Mortality
4.4. General Considerations
4.5. Strengths and Limitations
4.6. Implications for Practice and Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Ethical Approval
References
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Study | Design | Anticoagulant | Indication | Number of Patients | Age (Median, IQR) | Female (%) | Major GIB (%) | Intervention | Outcomes | Follow-Up Length (Months) | ||
Resumed | Did Not Resume | Resumed | Did Not Resume | |||||||||
Sengupta (2018) [37] | Retrospective cohort | Apixaban (n = 51, 4%) Rivaroxaban (n = 608, 45%) Dabigatran (n = 679, 51%) | AF | 586 | 752 | 78 (70–83) | 79 (71–84) | 687 (51) | n/a | Resumption during follow-up (median 40 days; IQR: 17-88) | 90-day/6 months hospital readmission with GIB or thromboembolic complications | 6 |
Valanejad (2020) [38] | Retrospective cohort | Apixaban (n = 18, 31.6%) Rivaroxaban (n = 34, 59.6%) Dabigatran (n = 5, 8.8%) | AF, DVT, PE | 37 | 18 | 75 (68–79) | 74.5 (71.3–82.5) | 31 (56) | 37 (67) a | Resume in ≤7 days from admission | 90-day hospital readmission with GIB, 12 months mortality | 12 |
Yanagisawa (2021) * [39] | Retrospective Cohort | Apixaban (n = 11, 20.8%) Rivaroxaban (n = 27, 50.9%) Dabigatran (n = 13, 24.5%) Edoxaban (n = 2, 3.8%) | AF | 45 | 8 | 77 | 79.5 | 23 (43.3) | 26 (46) b | Resumption during follow-up (90% in 14 days) | Recurrent GIB or MACCE during follow-up | 28 (10–44) d |
Hernandez (2017) * [40] | Retrospective cohort | Dabigatran (n = 276) (Warfarin) | AF | 92 | 184 | 79.64 (8.67) c | 81.9 (7.63) c | 225 (67.3) | 276 (100) a | Resume in 3 months | Recurrent GIB during follow-up * | 12 |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | DOACs | No Therapy | Relative (95% CI) | Absolute (95% CI) | ||
Recurrent bleeding (assessed with: event) | ||||||||||||
4 | observational studies | very serious a | not serious b | not serious | serious c | none | 53/741 (7.2%) | 67/981 (6.8%) | OR 1.09 (0.72 to 1.64) | 6 more per 1000 (from 18 fewer to 39 more) | ⨁◯◯◯ Very low | CRITICAL |
All-cause mortality (follow-up: mean 12; assessed with: event) | ||||||||||||
1 | observational studies | serious d | not serious | not serious | very serious c | none | 4/18 (22.2%) | 4/37 (10.8%) | OR 2.36 (0.52 to 10.78) | 114 more per 1000 (from 49 fewer to 458 more) | ⨁◯◯◯ Very low | IMPORTANT |
Thromboembolic event (follow-up: mean 3 months; assessed with: event) | ||||||||||||
1 | observational studies | very serious e | not serious | not serious | not serious | none | 16/586 (2.7%) | 17/752 (2.3%) | OR 1.21 (0.61 to 2.42) | 5 more per 1000 (from 9 fewer to 30 more) | ⨁◯◯◯ Very low | CRITICAL |
Majer adverse cardiac and cerebrovascular events (MACCE) | ||||||||||||
1 | observational studies | very serious e | not serious | not serious | very serious c | none | 1/45 (2.2%) | 3/8 (37.5%) | OR 0.037 (0.003 to 0.430) | 353 fewer per 1000 (from 373 fewer to 170 fewer) | ⨁◯◯◯ Very low | CRITICAL |
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Pálinkás, D.; Teutsch, B.; Gagyi, E.B.; Engh, M.A.; Kalló, P.; Veres, D.S.; Földvári-Nagy, L.; Hosszúfalusi, N.; Hegyi, P.; Erőss, B. No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis. Biomedicines 2023, 11, 554. https://doi.org/10.3390/biomedicines11020554
Pálinkás D, Teutsch B, Gagyi EB, Engh MA, Kalló P, Veres DS, Földvári-Nagy L, Hosszúfalusi N, Hegyi P, Erőss B. No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis. Biomedicines. 2023; 11(2):554. https://doi.org/10.3390/biomedicines11020554
Chicago/Turabian StylePálinkás, Dániel, Brigitta Teutsch, Endre Botond Gagyi, Marie Anne Engh, Patrícia Kalló, Dániel S. Veres, László Földvári-Nagy, Nóra Hosszúfalusi, Péter Hegyi, and Bálint Erőss. 2023. "No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis" Biomedicines 11, no. 2: 554. https://doi.org/10.3390/biomedicines11020554
APA StylePálinkás, D., Teutsch, B., Gagyi, E. B., Engh, M. A., Kalló, P., Veres, D. S., Földvári-Nagy, L., Hosszúfalusi, N., Hegyi, P., & Erőss, B. (2023). No Association between Gastrointestinal Rebleeding and DOAC Therapy Resumption: A Systematic Review and Meta-Analysis. Biomedicines, 11(2), 554. https://doi.org/10.3390/biomedicines11020554