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In elderly population prophylactic anticoagulation favors early detection of digestive trac

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    Journal of Geriatric Cardiology (2019) 16: 495497 ©2019 JGC All rights reserved;; [email protected] | Journal of Geriatric CardiologyLetter to the Editor  Open Access

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

    Malgorzata Szlendak1,2,#, Wojciech Myslinski1, Jerzy Mosiewicz1, Wojciech Barud11Department of Internal Diseases, Medical University in Lublin, Poland 2Human Anatomy Department, Medical University in Lublin, Poland J Geriatr Cardiol 2019; 16: 495497. doi:10.11909/j.issn.1671-5411.2019.06.008 Keywords: Anticoagulants; Colonic neoplasms; Gastrointestinal hemorrhage 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 Uni-versity of Lublin (Poland) the large group of hospitalised patients are the elderly with atrial fibrillation on the prophy-lactic 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 anti-coagulants 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 therapy- VKA, 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. #Correspondence to: [email protected], the additionally collected data encompassed: epidemiological data (age, sex), red blood cell parameters (Hb, RBC, MCV, and Ret), CHA2DS2-VASc and HAS-BLED scores and the information about the finally diagnosed cause of anemia. Following the definition of World Health Orga-nization, anemia was defined as haemoglobin concentration below 12 g/dL for women and below 13 g/dL for men. The epidemiological data about the population of the Lublin region was taken from publicly available data from the regional cancer registry.[1,2] GI tumors were defined according to the 10th revision of the International Statistical Classifi-cation of Diseases and Related Health Problems as codes C15–C21, which encompasses digestive tract from esophagus to anus. Statistical analysis was performed using Student’s t test. Value P < 0.1 was considered statistically significant. The study was accepted by the Bioethical Committee of the Medical University of Lublin (No. KE-0254/188/2018). Eventually, the study involved 150 patients, 87 women and 63 men. The number of 86 (57.3%) respondents was qualified as the elderly. Anemia was found in 75 patients (50%) and in 9 patients (6%) was caused by GI cancer. In the subgroup of the elderly GI cancer was diagnosed in seven cases and all of these neoplasms were colorectal cancers (CRC) (8.1%). Nevertheless, probably in three consecutive patients in this subgroup, anemia was also a result of developing cancer, but these patients did not agree or were disqualified from an endoscopic examination because of poor performance status. The median values of the CHA2DS2-VASc and HAS-BLED scales were alike in the patients with and without anemia, therefore they were not further analysed. A detailed analysis comparing anaemic patients with the entire study group and the elderly patients with anemia with all aged patients is presented in Table 1. More than half (58.7%) of all patients were treated with NOAC, 26% of patients used VKA and 15.3% were treated with LMWH. Similar statistics apply to

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