CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 17th, 2012

Resuming Warfarin After a GI Bleed: Benefits Appear to Outweigh the Risks

Many patients who’ve had a warfarin-associated gastrointestinal bleed can safely resume warfarin therapy soon after the bleeding event, according to an industry-funded, retrospective study in the Archives of Internal Medicine.

Researchers identified some 440 adults who experienced a GI bleed while taking warfarin; nearly 60% either stayed on warfarin continuously or resumed treatment within about a week (median time to retreatment, 4 days). Compared with patients who did not restart warfarin, those who continued or resumed treatment had a significantly lower 90-day incidence of thrombosis (0.4% vs. 5.5%) and death (6% vs. 20%). The most common causes of death were cancer, infection, and cardiac disease.

Patients who continued or restarted warfarin did have more recurrent GI bleeds (10% vs. 6%), but this difference did not achieve statistical significance. None of the recurrent bleeds were fatal.

Archives commentators conclude: “We believe that most patients with warfarin-associated GI bleeding and indications for continued long-term antithrombotic therapy should resume anticoagulation within the first week following the hemorrhage.”

Reprinted with permission from Physician’s First Watch.

Categories: Anticoagulation


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3 Responses to “Resuming Warfarin After a GI Bleed: Benefits Appear to Outweigh the Risks”

  1. Mohammad arif Abdullah, MD,FRCP says:
    September 21, 2012 at 3:35 am

    One week is reasonable but in some patients caution is required

  2. Dan Hackam, MD PhD says:
    September 21, 2012 at 8:30 am

    This actually dovetails very nicely with a randomized trial published by Sung in Annals 2.5 years ago, showing that continuing aspirin in the immediate aftermath of successfully controlled upper GI bleeding actually markedly reduces mortality risk.

  3. Edgar Abovich, MD says:
    September 21, 2012 at 8:34 am

    The conclusion is correct but very misleading. We can not extrapolate the data from healthier group(resumed warfarin early) to sick patient group(did not resumed warfarin early).