Management of colonic diverticular bleeding: A narrative review with literature search of current evidence and therapeutic strategies

Table 1 Risk factors for colonic diverticular bleeding

Category	Risk factors	Effect size/notes
Patient/anatomic	Age > 70 years	HR: 1.5-2.0; independent predictor of new-onset CDB
	Bilateral diverticulosis (right + left)	Key predictor of onset; higher cumulative incidence
	Hypertension/atherosclerosis	Contributes to vascular fragility of vasa recta
NSAIDs	Non-selective NSAIDs	OR = 6.90 (95%CI: 3.86-12.35); Longo et al[17] meta-analysis
	Aspirin (any dose)	OR = 2.84 (95%CI: 2.19-3.67)
	COX-2 selective inhibitors	Not associated with increased CDB risk
Antiplatelets	P2Y12 inhibitors (clopidogrel)	Increased LGIB risk; limited CDB-specific data
Anticoagulants	Vitamin K antagonists (warfarin)	Approximately 3-fold increased GI bleeding vs placebo
	Rivaroxaban vs apixaban	HR = 1.53 (95%CI: 1.00-2.33) higher LGIB risk with rivaroxaban
	DOACs vs antiplatelets	DOACs not shown to increase new-onset CDB
Combination	Dual antiplatelet + anticoagulant	Incidence approximately 70/1000 person-years
	Triple antithrombotic therapy	Highest risk combination; avoid when possible

GI: Gastrointestinal; NSAIDs: Non-steroidal anti-inflammatory drugs; HR: Hazard ratio; CDB: Colonic diverticular bleeding; COX-2: Cyclooxygenase-2; DOAC: Direct oral anticoagulant; OR: Odds ratio; CI: Confidence interval; LGIB: Lower gastrointestinal bleeding.