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AI-Generated response:

What is the correlation between atrial fibrillation and lower gastrointestinal bleed?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Atrial fibrillation is associated with an increased risk of lower gastrointestinal bleeding, primarily due to the use of anticoagulant therapy in these patients.

  • Patients with atrial fibrillation often require anticoagulation therapy to reduce the risk of stroke, which increases the risk of gastrointestinal bleeding.[1-3]

  • The median rate of major bleeding for patients on vitamin K antagonists, commonly used for atrial fibrillation, is about 2.51 bleeds per 100 patient years, with the gastrointestinal tract being the most common bleeding site.[2]

  • The risk of gastrointestinal bleeding is further elevated in patients with atrial fibrillation who are older or have other comorbid conditions such as liver disease or thrombocytopenia.[2]

  • In a study, lower gastrointestinal bleeding in anticoagulated patients with atrial fibrillation showed a significant association with the subsequent diagnosis of colorectal cancer, indicating that such bleeding might unmask an underlying condition like colorectal cancer.[4]

  • The HAS-BLED score is used to assess the risk of bleeding in patients with atrial fibrillation to guide the clinical decision on starting anticoagulation therapy.[3]

Additional info

When managing atrial fibrillation, particularly in patients requiring anticoagulation, it is crucial to balance the benefits of stroke prevention against the risks of bleeding. The HAS-BLED score can help in identifying patients at high risk of bleeding, which necessitates careful monitoring and possibly adjusting the anticoagulation therapy. Additionally, any episode of gastrointestinal bleeding in these patients warrants thorough investigation to rule out underlying pathologies such as colorectal cancer, especially given the high absolute risks of such cancer following bleeding episodes as indicated in the study.[4] This information is vital for guiding both the acute management of bleeding and the long-term care strategy for patients with atrial fibrillation.

References

Reference 1

1.

Elsevier ClinicalKey Derived Clinical Overview

Risk factors include use of antithrombotic agents, NSAID use, aspirin use, alcohol abuse, GI malignancy, atrial fibrillation, coagulopathies, prior GI bleed, cirrhosis, constipation, congenital malformations, radiation exposure, recent infectious illness, recent travel, abdominal aortic aneurysm (AAA) repair, and inflammatory bowel disease.,,

Reference 2

2.

Becker, Richard C., Ortel, Thomas L. (2024). In Goldman-Cecil Medicine (pp. 501). DOI: 10.1016/B978-0-323-93038-3.00070-8

The median rate of major bleeding for patients who are taking a vitamin K antagonist for atrial fibrillation therapy is about 2.51 bleeds per 100 patient years, and the most common bleeding site is the gastrointestinal tract. The risk of bleeding associated with the use of a vitamin K antagonist increases as the INR becomes increasingly supratherapeutic. The risk of bleeding also increases in patients whose INR results are difficult to manage, patients who concomitantly take aspirin or other antiplatelet therapies, older patients, and patients with comorbid conditions such as liver disease or thrombocytopenia.

Reference 3

3.

Elsevier ClinicalKey Clinical Overview

Synopsis Anticoagulation reduces ischemic stroke risk by approximately 60% In addition to stroke risk, consider bleeding risk before beginning anticoagulation, as this may, in some cases, temper the decision to start anticoagulation therapy. A simple guide is the HAS-BLED score. A high-risk score mandates correcting or minimizing modifiable risk factors and planning closer follow-up of the patient Hemodynamic instability is uncommonly a direct result of atrial fibrillation and mandates a rapid search for underlying reversible conditions (eg, sepsis, gastrointestinal bleeding) that are contributing to the instability Electrocardioversion of atrial fibrillation and subsequent maintenance of sinus rhythm are more likely to be successful when atrial fibrillation duration is less than 6 months Consider presence or absence of structural heart disease, coronary artery disease, and potential to prolong the QT interval when choosing the specific maintenance antiarrhythmic drug. Consultation with a cardiologist is recommended

Reference 4

4.

Rasmussen PV, Dalgaard F, Gislason GH, et al. European Heart Journal. 2022;43(7):e38-e44. doi:10.1093/eurheartj/ehz964.

Publish date: February 6, 2022.

AIMS: Gastrointestinal bleeding (GI-bleeding) is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) therapy. We sought to investigate to what extent lower GI-bleeding represents the unmasking of an occult colorectal cancer. METHODS AND RESULTS: A total of 125 418 Danish AF patients initiating OAC therapy were identified using Danish administrative registers. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risks of colorectal cancer in patients with and without lower GI-bleeding. During a maximum of 3 years of follow-up, we identified 2576 patients with lower GI-bleeding of whom 140 patients were subsequently diagnosed with colorectal cancer within the first year of lower GI-bleeding. In all age groups, we observed high risks of colorectal cancer after lower GI-bleeding. The absolute 1-year risk ranged from 3.7% [95% confidence interval (CI) 2.2-6.2] to 8.1% (95% CI 6.1-10.6) in the age groups ≤65 and 76-80 years of age, respectively. When comparing patients with and without lower GI-bleeding, we found increased risk ratios of colorectal cancer across all age groups with a risk ratio of 24.2 (95% CI 14.5-40.4) and 12.3 (95% CI 7.9-19.0) for the youngest and oldest age group of ≤65 and >85 years, respectively. CONCLUSION: In anticoagulated AF patients, lower GI-bleeding conferred high absolute risks of incident colorectal cancer.

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