Background and Importance Gastrointestinal bleeding related to antithrombotic therapy is a main cause of emergency department (ED) consultation. Data regarding the risk factors involved in the onset of new bleeding episodes associated with new anticoagulant treatment after the first episode is scarce.

Aim and Objectives To evaluate the frequency of ED re-visits among elderly patients with gastrointestinal bleeding secondary to direct oral anticoagulant (DOACs) treatment and to identify risk factors associated with an increased risk of ED re-visits.

Material and Methods A four years (2018–2022) retrospective observational study was designed, including adult patients (≥18 years) with atrial fibrillation and undergoing oral anticoagulation therapy who visited the ED for gastrointestinal bleeding. To evaluate the risk factors for 90 days re-visit, a multivariate analysis was designed including patients comorbidities, concomitant treatment, change in anticoagulant treatment and prescription of direct-acting oral anticoagulants.

Results 127 patients (Mean age (SD): 84.7 (7.6) years; 61.4% females) were included. At discharge, anticoagulation therapy was modified in 45 (35.4%) patients; changed from an oral anticoagulant to heparin in 18 (18.9%) patients, to another DOACs in 21 (46.7%) and to a vitamin K antagonist in four (0.9%). Anticoagulant treatment was withdrawn in eleven (9.0%) patients at discharge. 15 (12.2%) patients revisited the ED 90 days after hospital discharge for bleeding or thrombotic episodes. A non-significant decrease in the frequency of ED re-visits was observed in those patients who changed their anticoagulant treatment at discharge (10.1% vs 17.5%; p=0.241). In the multivariate analysis, chronic kidney disease was the only factor significantly associated with revisits at 90 days [OR: 1.58 (1.01–4.05)]

Conclusion and Relevance Elderly patients who experience a first episode of gastrointestinal bleeding have a high risk of re-visiting the ED for a bleeding episode. Those patients with antithrombotic change at discharge may decrease the risk of new emergency visits.

Conflict of Interest No conflict of interest.