In elderly population prophylactic anticoagulation favors early detection of digestive track cancers: an observational study in eastern Poland

Abstract

The launch of non-VKA oral anticoagulants (NOACs) caused revolution in thrombosis prevention, which was mainly due to their safety and simplicity in treatment when compared to vitamin K antagonists (VKA). Clinical observations indicate that despite the benefits of NOACs, many patients still use VKA even if they cannot cope with dose modifications and often do not control INR.  In the Department of Internal Diseases of Medical University of Lublin (Poland) the large group of hospitalised patients are the elderly with atrial fibrillation on the prophylactic antithrombotic therapy. Some of them have coexisting anemia and undergo extended diagnostics, which in the past had repeatedly resulted in the detection of gastrointestinal (GI) tumors at a very early stage that enabled an effective surgical treatment. The objectives of the presented study were: (1) compare the frequency of GI tumors detection among the elderly patients (defined as ≥ 75 years of age) treated with oral anticoagulants and their peers in entire population of the Lublin region (western Poland); and (2) determine if in the examined group of elderly patients there was a difference in the predisposition to bleeding depending on the used therapyVKA, NOAC and low molecular weight heparin (LMWH). Data presented in the study were collected prospectively for twelve months, from May 2017 to April 2018. The qualification conditions were an admission to the clinic due to anemia of the unknown reason and ongoing prophylactic antithrombotic therapy, mostly due to atrial fibrillation. The drugs used for this reason included: VKA-acenocoumarol and warfarin, NOAC-rivaroxaban, apixaban and dabigatran and LMWH in the form of enoxaparin. The therapy of some of the patients was modified during hospital stay, but the analysis included treatment applied before the admission to the clinic.