Antiplatelet and Anticoagulant Therapy in Patients With Gastrointestinal Bleeding

Almadi, Majid A; Barkun, Alan N.; Brophy, James M.

doi:10.1001/jama.2011.1653

Cited by 21 publications

(17 citation statements)

References 80 publications

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“…Temporary discontinuation of antithrombotic therapy is often necessary to control the bleeding and to prevent an early relapse (15). According to current evidence, the use of APAs as a secondary prophylaxis should be reinitiated as soon as possible after the episode of NVUGB (28), even if this would increase the rebleeding rate as it can potentially reduce overall mortality (29) and its discontinuation increases the risk of death and acute cardiovascular events by around sevenfold (30). In these cases, the protective effect of APAs exceeds their potential gastrotoxic effects.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

et al. 2016

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Background: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/ or anticoagulants and represents a clinical challenge in patients undergoing these therapies.Aim: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes.Methods: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012. The outcomes were compared between patients exposed and not exposed to antithrombotics.Results: Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years) were included, of which 43% received antithrombotics. Most patients had comorbidities. Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases. The 30-day mortality rate was 7.7% (n = 42), and 36% were bleeding-related. The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment. There were no significant differences between the exposed and non-exposed groups in most outcomes. Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL) and higher international normalized ratio (1.63 ± 1.13) were associated significantly with mortality in a univariate analysis.Conclusions: Adverse outcomes were not associated with antithrombotic use. The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.

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Section: Discussionmentioning

confidence: 99%

Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

et al. 2016

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“…They are resuscitation, risk assessment, preendoscopic care, endoscopic management, and postendoscopic care including pharmacological and nonpharmacological therapies. The issue of secondary prophylaxis will not be addressed in this particular paper, but readers are referred to a recent narrative review on the topic [7]. …”

Section: Introductionmentioning

confidence: 99%

The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

Dhahab

Barkun

2012

Ulcers

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Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of protonpump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment.

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“…12 A recent retrospective cohort study involving 442 patients found that patients who resumed warfarin therapy within 90 days of upper gastrointestinal bleeding (median resumption of 4 d) had de creased overall mortality and thrombosis without an increased risk of recurrent gastrointestinal bleeding. 13 Considering this limited evidence and the low-risk findings on endoscopy, the patient was comfortable restarting warfarin four days later.…”

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confidence: 99%