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All-cause mortality after major gastrointestinal bleeding among patients receiving direct oral anticoagulants: a protocol for a systematic review and meta-analysis

SYSTEMATIC REVIEWS (2022)

Journal

SYSTEMATIC REVIEWS

Volume 11, Issue 1, Pages -

Publisher

BMC

DOI: 10.1186/s13643-022-02146-5

Keywords

Bleeding; Direct oral anticoagulants; Mortality; Anticoagulation

Funding

Canadian Institutes of Health Research
Tier 2 Canada Research Chair in Anticoagulant Treatment of Cardiovascular Disease [CDT-142654]

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Abstract

This systematic review and meta-analysis aims to assess the 30-day all-cause mortality after major GI bleeding among patients receiving DOACs. The study will systematically search relevant literature, evaluate and extract data from selected studies, and pool the results through meta-analysis. The findings of this study will provide estimates of mortality after major bleeding events to support shared decision making about anticoagulation management for clinicians and patients.

Background:Gastrointestinal (GI) bleeding represents the single most frequent site of anticoagulant-related bleeding. Adverse outcomes after major GI bleeding including mortality are not well characterized and, as a result, may be underappreciated in clinical practice. We aim to conduct a systematic review and meta-analysis of the risk for 30-day all-cause mortality after major GI bleeding among patients receiving DOACs. Methods:Electronic databases including MEDLINE, EMBASE, and Cochrane CENTRAL will be systematically searched to identify randomized controlled trials and prospective and retrospective cohort studies reporting 30-day all-cause mortality in adults with DOAC-related major GI bleeding. At least two investigators will independently perform study selection, risk of bias assessment, and data extraction. The proportion of deaths following a major GI event relative to the number of major GI bleeding events will be calculated for each individual study, and results across studies will be pooled using random-effects meta-analysis. We will assess risk of bias using criteria proposed by the GRADE group for prognostic studies. Discussion:The findings of this systematic review and meta-analysis will provide clinicians and patients with estimates of mortality after the most common major bleeding event to support shared decision making about anticoagulation management.

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Bleeding Outcomes After Dental Extraction in Patients Under Direct-Acting Oral Anticoagulants vs. Vitamin K Antagonists: A Systematic Review and Meta-Analysis

Wenbing Hua, Zhengmei Huang, Zhuoli Huang

Summary: This systematic review found that patients receiving uninterrupted DOAC therapy may have a lower risk of bleeding after dental extraction. However, due to the limited quality of the evidence, the results should be interpreted with caution. Further studies with larger sample sizes are needed to support these conclusions.

FRONTIERS IN PHARMACOLOGY (2021)