Ravy K Vajravelu1, Ronac Mamtani2, Frank I Scott3, Adam Waxman2, James D Lewis4. 1. Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: ravy.vajravelu@uphs.upenn.edu. 2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Gastroenterology, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado. 4. Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND & AIMS: Although recurrent diverticular hemorrhage is common, its incidence and risk factors have not been measured outside of small institutional cohorts. We analyzed the incidence of and risk factors for recurrent diverticular hemorrhage and whether discontinuing anticoagulation after diverticular hemorrhage is associated with ischemic stroke. METHODS: We performed a retrospective cohort study of patients enrolled in the OptumInsight Clinformatics database from 2000 through 2016. Incidence rates for initial and recurrent diverticular hemorrhage were calculated by identifying patients who had hospitalizations with a primary discharge diagnosis consistent with diverticular hemorrhage. The hazard ratios of second diverticular hemorrhage associated with anticoagulants or platelet aggregation inhibitors were calculated using Cox proportional hazards regression adjusted for demographics, comorbidities, and medication use. The hazard ratio for ischemic stroke among patients who discontinued anticoagulation after diverticular hemorrhage was calculated similarly. RESULTS: In the cohort analyzed, 14,925 patients had an initial diverticular hemorrhage; 1368 of these patients had a second episode. The unstandardized incidence rates of initial and second diverticular hemorrhage were 10.9 per 100,000 person-years (95% confidence interval [CI] 10.7-11.0) and 3625.6 per 100,000 person-years (95% CI 3436.0-3823.0). Platelet aggregation inhibitors were associated with second episodes of diverticular hemorrhage (hazard ratio 1.47; 95% CI 1.15-1.88), whereas all classes of anticoagulation agents were not associated. Among patients with a potential indication for stroke prophylaxis, those who discontinued anticoagulation after the diverticular hemorrhage had an increased hazard of ischemic stroke (hazard ratio 1.93; 95% CI 1.17-3.19). CONCLUSIONS: In this retrospective cohort study, platelet aggregation inhibitors, but not anticoagulants, were associated with recurrent diverticular hemorrhage. Discontinuing anticoagulation was associated with increased hazard for ischemic stroke.
BACKGROUND & AIMS: Although recurrent diverticular hemorrhage is common, its incidence and risk factors have not been measured outside of small institutional cohorts. We analyzed the incidence of and risk factors for recurrent diverticular hemorrhage and whether discontinuing anticoagulation after diverticular hemorrhage is associated with ischemic stroke. METHODS: We performed a retrospective cohort study of patients enrolled in the OptumInsight Clinformatics database from 2000 through 2016. Incidence rates for initial and recurrent diverticular hemorrhage were calculated by identifying patients who had hospitalizations with a primary discharge diagnosis consistent with diverticular hemorrhage. The hazard ratios of second diverticular hemorrhage associated with anticoagulants or platelet aggregation inhibitors were calculated using Cox proportional hazards regression adjusted for demographics, comorbidities, and medication use. The hazard ratio for ischemic stroke among patients who discontinued anticoagulation after diverticular hemorrhage was calculated similarly. RESULTS: In the cohort analyzed, 14,925 patients had an initial diverticular hemorrhage; 1368 of these patients had a second episode. The unstandardized incidence rates of initial and second diverticular hemorrhage were 10.9 per 100,000 person-years (95% confidence interval [CI] 10.7-11.0) and 3625.6 per 100,000 person-years (95% CI 3436.0-3823.0). Platelet aggregation inhibitors were associated with second episodes of diverticular hemorrhage (hazard ratio 1.47; 95% CI 1.15-1.88), whereas all classes of anticoagulation agents were not associated. Among patients with a potential indication for stroke prophylaxis, those who discontinued anticoagulation after the diverticular hemorrhage had an increased hazard of ischemic stroke (hazard ratio 1.93; 95% CI 1.17-3.19). CONCLUSIONS: In this retrospective cohort study, platelet aggregation inhibitors, but not anticoagulants, were associated with recurrent diverticular hemorrhage. Discontinuing anticoagulation was associated with increased hazard for ischemic stroke.
Authors: Kathryn F Flack; Jay Desai; Jennifer M Kolb; Prapti Chatterjee; Lars C Wallentin; Michael Ezekowitz; Salim Yusuf; Stuart Connolly; Paul Reilly; Martina Brueckmann; John Ilgenfritz; James Aisenberg Journal: Clin Gastroenterol Hepatol Date: 2016-10-17 Impact factor: 11.382
Authors: Lisa L Strate; Yan L Liu; Edward S Huang; Edward L Giovannucci; Andrew T Chan Journal: Gastroenterology Date: 2011-02-12 Impact factor: 22.682
Authors: N Sengupta; J D Feuerstein; V R Patwardhan; E B Tapper; G A Ketwaroo; A M Thaker; D A Leffler Journal: Am J Gastroenterol Date: 2014-12-16 Impact factor: 10.864
Authors: Gwen M C Masclee; Vera E Valkhoff; Preciosa M Coloma; Maria de Ridder; Silvana Romio; Martijn J Schuemie; Ron Herings; Rosa Gini; Giampiero Mazzaglia; Gino Picelli; Lorenza Scotti; Lars Pedersen; Ernst J Kuipers; Johan van der Lei; Miriam C J M Sturkenboom Journal: Gastroenterology Date: 2014-06-14 Impact factor: 22.682
Authors: Ravy K Vajravelu; Jennifer M Kolb; Shivani U Thanawala; Frank I Scott; Samuel Han; Amit G Singal; Gary W Falk; David A Katzka; Sachin Wani Journal: Clin Gastroenterol Hepatol Date: 2021-02-05 Impact factor: 13.576
Authors: Frank I Scott; Ravy K Vajravelu; Ronac Mamtani; Nicholas Bianchina; Najjia Mahmoud; Jason K Hou; Qufei Wu; Xingmei Wang; Kevin Haynes; James D Lewis Journal: JAMA Netw Open Date: 2021-02-01