Antithrombotic Therapy Was Not a Risk Factor for Recurrence in Patients with Diverticular Bleeding

Abstract

Introduction: In Japan, patients with colonic diverticulosis and diverticular bleeding have been increased in concomitant with aging and Westernization. Our previous report indicated that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) was a risk factor for diverticular bleeding and recurrent bleeding, and the influence of antithrombotic drugs in diverticular bleeding remains elusive. Recently, a new treatment method (endoscopic band ligation: EBL) and novel oral anticoagulant (NOAC) were developed, therefore background factors of patients with diverticular bleeding have been changed. The present study aimed to clarify risk factors of recurrent bleeding in colorectal diverticular bleeding. Methods: The present study enrolled 154 patients (male/female:100/54) with colorectal diverticular bleeding who were admitted to our hospital from January 2000 to March 2016. Risk factors for recurrent bleeding in these patients were analyzed. Results: The mean age of the patients was 70.0 years old (range,39-96 years old). Most patients were managed with conservative treatment (n=113, 73.4%), endoscopic clip placement was performed in 31 patients, EBL in eight patients, and vascular embolization in two patients, There were 42 patients on antithrombotic drugs (low-dose aspirin; 25 patients, anticoagulants; 13 patients including combination therapy), and 16 patients taking NSAIDs (including overlapping of antithrombotic drugs). Recurrent bleeding occurred in 48 patients (31.2%), and neither gender nor age affected the rate of recurrent bleeding. The risk factors for recurrent bleeding were constipation disease (p=0.011), use of bisphosphonates (p=0.012), and habits of alcohol consumption (p=0.034). Antithrombotic drugs and NSAIDs was not a risk factor for recurrent bleeding. The applied method for treatment did not influence the rate of recurrent bleeding. Conclusion: In patients with diverticular bleeding, the rate of antithrombotic drug use increased whereas the rate of recurrence did not increase. This result strongly suggested that antithrombotic therapy in the diverticular bleeding patient could be restarted as soon as possible.