All-Cause Mortality after Major Gastrointestinal Bleeding Among Patients Receiving Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Background: Bleeding is the major complication of anticoagulant use, including direct oral anticoagulants (DOACs). Although major gastrointestinal (GI) bleeding represents the single most frequent site of anticoagulant-related bleeding, outcomes after major GI bleeding including mortality are not well characterized and, as a result, severity may be underappreciated with resulting implications for clinical practice. We conducted a systematic review and meta-analysis to quantify the risk for 30-day all-cause mortality after major GI bleeding among DOAC treated patients. Methods: The systematic review protocol was registered with PROSPERO (CRD42022295815). We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to November 26 th, 2021 for studies that met the following inclusion criteria: (i) were randomized controlled trials, or prospective and retrospective cohort studies, (ii) included adults treated with a DOAC for venous thromboembolism (VTE) or atrial fibrillation; and (iii) reported 30-day all-cause mortality after major GI bleeding. Two reviewers independently performed study screening and data extraction in duplicate. Summary estimates for 30-day all-cause mortality were calculated using the random-effects inverse-variance method. Statistical heterogeneity was evaluated using the I 2 statistic and by providing 95% prediction intervals. In a sensitivity analysis, we included only studies that defined major GI bleeding based on the International Society on Thrombosis and Haemostasis (ISTH) criteria. Subgroup analyses were performed according to indication for anticoagulation and type of DOAC. Risk of bias was assessed using a modified version of the QUIPS tool for prognostic studies. Results: Of 6548 unique studies identified in our search, we included 17 studies which comprised a total of 3910 DOAC-treated patients with major GI bleeds. The pooled estimate of 30-day mortality after a major GI bleed was 9% (95% CI, 7-13%; I 2=76%) (Figure). In a sensitivity analysis, limited to 15 studies (1846 major GI bleeds) that used the ISTH major GI bleeding definition, the pooled estimate of 30-day mortality was 9% (95% CI, 6-13%; I 2=75%; 95% prediction interval, 2-29%). Studies deemed to be at high risk of bias (5 studies, 228 major GI bleeds) had higher mortality (14%; 95% CI, 8-24%; I 2=8%) than those at low risk of bias (11 studies, 3644 major GI bleeds) where mortality was 8% (95% CI, 6-12%; I 2=81%). In patients receiving a DOAC for either VTE or atrial fibrillation (14 studies, 2764 major GI bleeds), the pooled estimate of 30-day mortality was 11% (95% CI, 7-16%; I 2=10%), and in those receiving a DOAC for atrial fibrillation (3 studies, 1119 major GI bleeds), it was 5% (95% CI, 2-14%; I 2=84%). The pooled estimate of 30-day mortality was 9% (95% CI, 6-14%; I 2=80%) in patients on any DOAC (15 studies, 3747 major GI bleeds), 13% (95% CI, 8-20%; I 2=0%) among those on dabigatran (2 studies, 125 major GI bleeds), and 3% (95% CI, 0-13%) among those rivaroxaban (only 1 study, 38 major GI bleeds). Conclusion: DOAC related major GI bleeding is associated with a significant risk of 30-day mortality. We found substantial heterogeneity across studies which limits the certainty of summary estimates and the ability to compare between DOACs and indications for treatment. Studies reporting on anticoagulation usage should more report on outcomes such as all-cause mortality after bleeding events to better characterize the potential harms of therapy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,030 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,021 | 0,046 |
| Bibliométrie | 0,008 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».