{"id":2281,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/le-pronostic-des-hemorragies-digestives-hautes-sous-anticoagulants-oraux-directs-ou-sous-anti-vitamines-k-est-similaire-resultats-de-lanalyse-de-sous-groupe-de-sanghria\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"le-pronostic-des-hemorragies-digestives-hautes-sous-anticoagulants-oraux-directs-ou-sous-anti-vitamines-k-est-similaire-resultats-de-lanalyse-de-sous-groupe-de-sanghria","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/le-pronostic-des-hemorragies-digestives-hautes-sous-anticoagulants-oraux-directs-ou-sous-anti-vitamines-k-est-similaire-resultats-de-lanalyse-de-sous-groupe-de-sanghria\/","title":{"rendered":"LE PRONOSTIC DES HEMORRAGIES DIGESTIVES HAUTES SOUS ANTICOAGULANTS ORAUX DIRECTS OU SOUS ANTI-VITAMINES K EST SIMILAIRE : RESULTATS DE L\u2019ANALYSE DE SOUS-GROUPE DE SANGHRIA"},"content":{"rendered":"

2019<\/strong><\/p>\n

C. GOURIOU (1); G. BOUGUEN (1); P. LAHMEK (2); A. PELAQUIER (3); G. D\u2019HAUTEFEUILLE (4); D. LOUVEL (5); M. MOUSSAOUI (6); C. BERGER (7); H. VANDAMME (8); A. BERETE (9); R. AROTCARENA (10); A. GARIOUD (11); S. DE MONTIGNY-LENHARDT (12); J-G. BERTOLINO (13); E. CUILLERIER (14); A. PAUWELS (15); D. ZANDITENAS (16); C. CHARPIGNON (17); Q.THIEBAULT (18); R. COMBES (19); Y. ARONDEL (20); S. GRIMBERT (21); B. LE GUILLOU (22); I. BOREL (23) S. NAHON (24); V. QUENTIN (25).
\n(1) CHU Rennes Pontchaillou, Rennes, France; (2) HU-Henri Mondor, Limeil-Br\u00e9vannes, France; (3) Groupement Hospitalier Portes de Provence, Mont\u00e9limar, France; (4) Centre Hospitalier Arles, Arles, France; (5) Centre Hospitalier de Cayenne, Cayenne, Guyane; (6) Centre Hospitalier Sud Essonne, Dourdan-Etampes, France; (7) Centre Hospitalier M\u00e2con, M\u00e2con, France; (8) Centre Hospitalier B\u00e9thune, Beuvry, France; (9) Centre Hospitalier Nevers, Nevers, France; (10) Centre Hospitalier Pau, Pau, France; (11) Centre Hospitalier GHPSO Creil, Creil, France; (12) Centre Hospitalier G\u00e9n\u00e9ral Edmond Garcin, Aubagne, France; (13) Centre Hospitalier Intercommunal des Alpes du Sud, Gap, France; (14) Centre Hospitalier Dreux, Dreux, France; (15) Centre Hospitalier Gonesse, Gonesse, France; (16) H\u00f4pital Saint Camille, Bry-sur-Marne, France; (17) Institut Mutualiste Montsouris, Paris, France; (18) Centre Hospitalier Angoul\u00eame, Angoul\u00eame, France; (19) Centre Hospitalier Niort, Niort, France; (20) Centre Hospitalier Haguenau, Haguenau, France; (21) Groupe Hospitalier Diaconesse Croix Saint Simon, Paris, France; (22) Centre Hospitalier Narbonne, Narbonne, France; (23) Centre Hospitalier Voiron, Voiron, France; (24) Centre Hospitalier Montfermeil, Montfermeil, France; (25) Centre Hospitalier de St Brieuc, Saint-Brieuc, France<\/p>\n

Institution : ANGH pour le groupe d’\u00e9tude SANGHRIA<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02019-05-11 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction et objectif de l\u2019\u00e9tude :
\nLa gestion d\u2019un traitement anticoagulant oral reste probl\u00e9matique dans le cadre des h\u00e9morragies digestives hautes. Chez les patients trait\u00e9s par antivitamines K (AVK), le pronostic ne semble pas impact\u00e9 (1) mais une antagonisation est possible contrairement aux anticoagulants oraux directs (AOD). Depuis les essais princeps, le risque h\u00e9morragique associ\u00e9 aux AOD reste controvers\u00e9 avec des donn\u00e9es en faveur d\u2019une augmentation des h\u00e9morragies digestives (2). Le but de cette \u00e9tude est de d\u00e9crire l\u2019\u00e9pid\u00e9miologie, le traitement endoscopique et le pronostic des h\u00e9morragies digestives hautes survenant chez des patients trait\u00e9s par un anticoagulant oral.
\nM\u00e9thodes :
\nDe novembre 2017 \u00e0 octobre 2018, l\u2019\u00e9tude prospective multicentrique SANGHRIA men\u00e9e dans des centres hospitaliers g\u00e9n\u00e9raux a inclus tout patient pr\u00e9sentant un tableau d\u2019h\u00e9morragie digestive haute. Un questionnaire en ligne (eCRF) a \u00e9t\u00e9 utilis\u00e9 pour le recueil des donn\u00e9es. Au sein de la cohorte, tous les patients trait\u00e9s par anticoagulant oral ont \u00e9t\u00e9 extraits et analys\u00e9s. L\u2019\u00e9valuation du pronostic portait sur la mortalit\u00e9 \u00e0 6 semaines, la r\u00e9cidive h\u00e9morragique dans les 6 premi\u00e8res semaines et la n\u00e9cessit\u00e9 d\u2019un traitement chirurgical ou radio-interventionnel.
\nR\u00e9sultats :
\nParmi les 2498 patients inclus, 475 (19 %) avaient un anticoagulant oral : 267 (56,2 %) par AVK (Warfarine 67 (25 %), Fluindione 200 (75 %)) et 208 (43,8 %) par AOD (Dabigatran 21 (10 %), Rivaroxaban 114 (55 %), Apixaban 73 (35%)). La cohorte de patients sous anticoagulants \u00e9tait compos\u00e9e de 65 % d\u2019hommes, avec un \u00e2ge moyen de 78,2 ans, et un score de comorbidit\u00e9s de Charlson de 3,2. Cent patients (21 %) avaient une com\u00e9dication par aspirine et 55 (11,6 %) par un antiagr\u00e9gant plaquettaire. Il n\u2019y avait pas de diff\u00e9rences entre les groupes AVK et AOD sauf concernant les ant\u00e9c\u00e9dents de cirrhose et d\u2019insuffisance r\u00e9nale (plus \u00e9lev\u00e9s dans le groupe AVK). La quasi-totalit\u00e9 des patients (470) a eu une endoscopie oeso-gastro-duod\u00e9nale (98,9 %), consid\u00e9r\u00e9e normale chez 73 patients (15,3 %) et r\u00e9v\u00e9lant un saignement actif chez 117 patients (24,9 %). L\u2019origine de l\u2019h\u00e9morragie \u00e9tait attribu\u00e9e \u00e0 une l\u00e9sion peptique pour 289 patients (60,8 %), en lien avec l\u2019hypertension portale pour 43 patients (9 %), d\u2019origine vasculaire et tumorale pour 41 (8,6 %) et 27 (5,7 %) patients respectivement sans diff\u00e9rence selon le type d\u2019anticoagulant. Un traitement endoscopique a \u00e9t\u00e9 r\u00e9alis\u00e9 chez 128 patients (26,9 %) permettant l\u2019arr\u00eat du saignement chez 90 patients (20 %).
\nLa mortalit\u00e9 \u00e0 6 semaines \u00e9tait de 12,4 % (59 patients), plus \u00e9lev\u00e9e dans le groupe de patients sous AVK (16,1 %) que sous AOD (7,8 %) ; p < 0,01. En analyse univari\u00e9e, les facteurs associ\u00e9s \u00e0 la mortalit\u00e9 \u00e9taient le score de Charlson > 5, l\u2019anticoagulation par AVK, la pr\u00e9sence d\u2019un \u00e9tat de choc \u00e0 l\u2019admission, l\u2019origine peptique de la l\u00e9sion \u00e0 l\u2019endoscopie, un score de Rockall > 2 et de Blatchford \u2265 14. Seul le score de Charlson restait significatif en analyse multivari\u00e9e (OR 4,14, p < 0,0001). Cinquante-six patients (11,8 %) ont pr\u00e9sent\u00e9 une r\u00e9cidive h\u00e9morragique (AVK 30 (11,2 %), AOD 26 (12,5 %), p = 0.71). La com\u00e9dication par un antiagr\u00e9gant plaquettaire \u00e9tait associ\u00e9e \u00e0 un risqu\u00e9 plus \u00e9lev\u00e9 de r\u00e9cidive en analyse multivari\u00e9e (OR 2,72, p = 0,009) alors que les b\u00e9tabloquants semblaient \u00eatre protecteurs (OR = 0.41, p = 0,0072). Le recours \u00e0 un traitement chirurgical ou radio-interventionnel a \u00e9t\u00e9 n\u00e9cessaire pour 18 patients (3,8 % : AVK 10 (2,1 %), AOD 8 (1,6 %) p = 0.95). L\u2019origine tumorale du saignement \u00e9tait le seul facteur associ\u00e9 en analyse multivari\u00e9e (OR = 6.66, p = 0.0064).\nConclusion : Les AOD ne semblent pas aggraver le pronostic des h\u00e9morragies digestives hautes par rapport aux AVK. Les comorbidit\u00e9s et traitements associ\u00e9s s\u2019av\u00e8rent \u00eatre les facteurs les plus impactant sur la mortalit\u00e9, la r\u00e9cidive ou le recours \u00e0 un traitement compl\u00e9mentaire. \nR\u00e9f\u00e9rences\n1. \tNahon S, Hag\u00e8ge H, Latrive JP, Rosa I, Nalet B, Bour B, et al. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study. Endoscopy. 2012 Nov;44(11):998\u20131008. \n2. \tRuff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet Lond Engl. 2014 Mar 15;383(9921):955\u201362. \n3. \tAbraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND. Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study. Gastroenterology. 2017;152(5):1014-1022.e1. \n4. \tMiller CS, Dorreen A, Martel M, Huynh T, Barkun AN. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2017 Nov;15(11):1674-1683.e3.\n<\/p>\n","protected":false},"excerpt":{"rendered":"

2019 C. GOURIOU (1); G. BOUGUEN (1); P. LAHMEK (2); A. PELAQUIER (3); G. D\u2019HAUTEFEUILLE (4); D. LOUVEL (5); M. MOUSSAOUI (6); C. BERGER (7); H. VANDAMME (8); A. BERETE (9); R. AROTCARENA (10); A. GARIOUD (11); S. DE MONTIGNY-LENHARDT (12); J-G. BERTOLINO (13); E. CUILLERIER (14); A. PAUWELS (15); D. ZANDITENAS (16); C. CHARPIGNON […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[30],"class_list":["post-2281","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-30"],"yoast_head":"\nLE PRONOSTIC DES HEMORRAGIES DIGESTIVES HAUTES SOUS ANTICOAGULANTS ORAUX DIRECTS OU SOUS ANTI-VITAMINES K EST SIMILAIRE : RESULTATS DE L\u2019ANALYSE DE SOUS-GROUPE DE SANGHRIA - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/le-pronostic-des-hemorragies-digestives-hautes-sous-anticoagulants-oraux-directs-ou-sous-anti-vitamines-k-est-similaire-resultats-de-lanalyse-de-sous-groupe-de-sanghria\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"LE PRONOSTIC DES HEMORRAGIES DIGESTIVES HAUTES SOUS ANTICOAGULANTS ORAUX DIRECTS OU SOUS ANTI-VITAMINES K EST SIMILAIRE : RESULTATS DE L\u2019ANALYSE DE SOUS-GROUPE DE SANGHRIA - 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