An easy nomogram to predict 30-day mortality in warfarin overdose patients undergoing endoscopy for gastrointestinal bleeding

INTRODUCTION: Gastrointestinal bleeding (GIB) is a crucial medical issue in patients receiving oral anticoagulant therapy. Thus, the management of these patients is important in daily clinical practice. In this study, first, we sought to show the predictors of mortality and, second, provide a nomogram for clinicians to evaluate the risk of mortality in patients undergoing endoscopic therapy with warfarin overdose.
METHODS: Patients who underwent endoscopic treatment with warfarin overdose and GIB between February 15, 2019, and March 20, 2021, were retrospectively evaluated. Clinical, demographic, and laboratory parameters of patients were recorded. The primary outcome was 30-day all-cause mortality after the procedure.
RESULTS: A total of 359 patients admitted with warfarin overdose and GIB who underwent endoscopic treatment were included in the study. All cause death was observed in 50 (14%) patients in the 30-day period after the procedure. According to univariate and multivariate logistic regression analysis, age (OR=1.019; 95% CI=1.000–1.039; p=0.008), hypertension (OR=1.909; 95% CI=1.051–3.468; p=0.004), alcohol history (OR=1.618; 95% Cl=1.196–2.954; p=0.018), and albumin value (OR=0.318; 95% Cl=0.214–0.471; p=0.001) were determined as independent predictors for 30-day all-cause mortality. The areas under the curves of the nomogram were 0.73 (95% CI: 0.70–0.76) may have clinical usefulness.
DISCUSSION AND CONCLUSION: This study provides a nomogram containing age, hypertension, alcohol, and albumin that can be conveniently used to predict individual mortality in warfarin overdose patients undergoing endoscopy for GIB.