(TKP2021-EGA-23) Funder: Ministry for Innovation and Technology
Subjects:
Meta-analysis
There are recommendations for anticoagulation resumption after gastrointestinal bleeding
(GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated
patients is lacking. We aim to determine the safety and efficacy of restarting DOACs
after GIB.Studies that reported rebleeding, thromboembolic events, and mortality after
restarting or withholding DOACs were selected. The systematic research was conducted
in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Scopus). The random
effect model was implemented to calculate the pooled odds ratio (OR). The ROBINS-I
tool was used for risk of bias assessment, and the certainty of the evidence was evaluated
with the GRADE approach.Four retrospective cohort studies (1722 patients) were included
in the meta-analysis. We did not find a significant increase in the risk of rebleeding
in patients restarting DOACs after index GIB (OR = 1.12; 95% CI: 0.74-1.68). The outcomes
of thromboembolic events and mortality data were not suitable for meta-analytic calculations.
Single studies did not show statistically significant differences. Data quality assessment
showed a serious overall risk of bias and very low quality of evidence (GRADE D).DOAC
resumption after a GIB episode may not elevate the risk of rebleeding. However, the
need for high-quality randomized clinical trials is crucial.
