Clinical and epidemiological profile of digestive hemorragia during VKA overdosage in elderly subjects

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Aims All anticoagulant treatments, whether preventive or curative, maybe responsible for digestive hemorrhage (DH). These are essentially anti-vitamin K drugs (VKA), most often due to dosage errors. The management of these patients poses a major therapeutic problem, since the hemorrhage occurs in elderly patients at high thrombo-embolic risk, with the increased incidence of severity of these DH. The aim of this study was to clarify the epidemiological, clinical and evolutionary of DH in elderly patients with VKA overdosage. Methods It is a retrospective descriptive study over a 10-year period from January 1, 2010, to December 31, 2020, including all patients over 60 years of age hospitalized in the Gastroenterology Department at CHU Sahloul in Sousse (Tunisia) for digestive hemorrhage related to VKA overdosage Results The total number of patients included in the study was 36. These included 11 men (30.55%) and 25 women (69.45%). The mean age was 77 years. The indication for VKA treatment was: atrial fibrillation (48.17%), valve replacement (37.3%), and deep vein thrombosis (7.8%). Hemorrhage was externalized as melena (58.8%), hematemesis (31.4%), and rectal bleeding (23.5%). None of our patients presented with shock; 16.7% were tachycardic, and 5.9% had hypotension. DH was confirmed in 82.3% of cases by digital rectal examination. Laboratory analysis revealed anemia (Hemoglobin<10 g/dl) in 90.3% of cases, the mean prothrombin time (PT) level was 15.76±6.32, the mean INR value at diagnosis was 10.25±3.03, and the mean urea level was 15.44±10.85 mmol/L. The lesions responsible for hemorrhage were: peptic ulcer disease (19.5%), esophageal disease (12.7%), recto-colonic tumors (2.77%), colonic diverticulosis (12.2%), colonic angiodysplasia (5.55%), and ulcerative colitis (5.55%). With regard to management, immediate discontinuation of anticoagulants was done in all patients, in parallel with the administration of vitamin K and prothrombin complex concentrate (PPSB). Twenty-eight patients (77.7%) received red blood cells (RBCs) with an average of 3 RBCs transfused. We used endoscopic treatment in 3 patients (8.31%); one patient had an elastic ligation of esophageal varices, one patient was treated with argon plasma, and one patient received an injection of adrenaline. We had surgical treatment in one patient (total colectomy for uncontrollable DH). Most cases were favorable in the majority of cases (97.22%). Death occurred in 1 patient following a recurrence of severe hemorrhage. Conclusions Digestive hemorrhage on VKAs is a serious complication, particularly all the more so if it occurs in an elderly, multi-morbid subject. It is therefore always important to weigh the risk-benefit ratio before introducing long-term anticoagulant therapy. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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