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Corresponding Author

Mohamed Elsayed Sarhan

Document Type

Original Article

Abstract

Background: A hypercoagulable state is one of the main pathologic events in COVID-19 patients.

Aim of the study: To assess the possible bleeding sources and proper endoscopic interventions in patients cleared from COVID-19 but still receiving direct oral anticoagulants (DOACs).

Methods: We conducted this prospective study on 305 patients with first-attack upper gastrointestinal bleeding, recently finished COVID-19 treatment, and still using DOACs as a thromboprophylaxis.

Results: DOAC used were Rivaroxaban 10 mg once daily in 150 (49.18%) patients, Apixaban 2.5 mg BID in131 (42.95%) patients, Apixaban 5 mg BID in 15 (4.92%) patients, Rivaroxaban 20 mg in 9 (2.95%) patients. Variceal bleeding occurred in 162 patients, while nonvariceal bleeding occurred in 143 patients. Intervention was endoscopic band ligation (EBL) in 100 (32.79%) patients, Argon plasma coagulation in 71 (23.28%) patients, diluted epinephrine injection in 42 (13.77%) patients, EBL plus cyanoacrylate injection in 25 (8.20%) patients, Hemoclips in 19 (6.23%) patients, Cyanoacrylate injection in 12 (3.93%) patients and Hemospray in 11 (3.61%) patients. 279 (91%) patients improved after the first endoscopic intervention, rebleeding occurred in 21 (7%) of patients, while 5 (2%) of patients died due to different causes.

Conclusions: Esophageal varices were the most common bleeding site in post-COVID-19 patients, and the endoscopic band ligation intervention was the proper endoscopic intervention with 91% improvement. The risk of gastrointestinal bleeding after DOAC use should be considered, and proper patient selection according to the risk-cost-benefit ratio is of value.

Keywords

Gastrointestinal bleeding, COVID-19, Direct oral anticoagulants

Subject Area

Internal Medicine

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