P0764 Are anticoagulants safe in patients with Inflammatory Bowel Disease?
Authors: Rivas C , García M J , Alonso Fernández S , Castro B , Cuadrado A , Rivero M 
Published: January 2025

Background

Inflammatory bowel disease (IBD) patients may have a higher risk of gastrointestinal bleeding during anticoagulant treatment due to mucosal erosions. Millions of patients worldwide receive classic oral anticoagulants or direct-acting anticoagulants (DOACs).The main indication is stroke prophylaxis in atrial fibrillation (AF), with an increasing prevalence in older age groups (8.5% of the Spanish population over 60 years old).Anticoagulants (especially DOACs) safety data are limited in IBD. Our objective was to evaluate the bleeding risk in IBD concerning these treatments.

Methods

A single-center retrospective study was conducted, collecting clinical characteristics, laboratory parameters and bleeding events. Bleeding risk was compared in two cohorts of IBD patients over 60 years old, treated with anticoagulants or not matched by age, sex, and type of IBD at a ratio of 2 controls for each anticoagulated case. We classified the severity of bleeding events as major or not according to the International Society on Thrombosis and Haemostasis criteria. Major bleeding is defined as fatal or symptomatic bleeding in a critical organ, with a decrease of 2 g/dL in hemoglobin or transfusion of 2 or more units. Chi-square test and Student's t-test were used to compare qualitative or quantitative variables respectively

Results

186 subjects were analyzed (62 anticoagulated, 124 were not): 110 had ulcerative colitis (UC) and 76 Crohn's disease (CD). Baseline characteristics are described in Table 1. Of the 62 anticoagulated patients, 69% were on DOACs (26 apixaban,7 edoxaban,6 rivaroxaban,4 dabigatran)26% on classic oral anticoagulants and 5% on low molecular weight heparin. The main indication was AF (66%), followed by thrombosis (26%) and stroke (8%). No statistically significant differences were found in sex, age, location, behavior (CD), or extent of the disease, which was expected since controls were matched for these factors. There were 17 hemorrhagic events (9.1%) and 58,8% were major. The main bleeding cause was gastrointestinal (64.7%) followed by urinary (23.5%). Bleeding was significantly higher with anticoagulation (17.7 vs 4.8%, p=0.004) and specifically with NOACs (20.9 vs 4.8%; p=0.001). Analyzing only the bleeding cases, no statistically significant differences were found in the incidence of major bleeding, need for admission, iron therapy or transfusion with classic anticoagulants or NOACs, nor in hemoglobin or inflammatory parameters (Table 2). All cause mortality was higher in anticoagulated patients (19.4 vs 6.5%; p= 0.007); one case was 2º to digestive bleeding

Conclusion

IBD patients may have a higher risk of gastrointestinal bleeding during anticoagulant treatment (specifically DOACs), so they may require closer monitoring

References

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-Viola A, Chiappetta MF, Scolaro M, Bignoli F, Versace A, Fries W. Direct oral anticoagulants increase the risk of anaemia and hospitalization in IBD patients with active intestinal disease. Dig Liver Dis. 2020 Dec;52(12):1525-1526. doi: 10.1016/j.dld.2020.08.033. Epub 2020 Sep 6. PMID: 32900651.