Risks of Bleeding Recurrence and Cardiovascular Events With Continued Aspirin Use After Lower Gastrointestinal Hemorrhage

Chan, Francis K.L.; Ki, En–Ling Leung; Wong, Grace Lai–Hung; Ching, Jessica; Tse, Yee Kit; Au, Kim Wl; Wu, Justin Che Yuen; Ng, Siew C.

doi:10.1053/j.gastro.2016.04.013

Cited by 64 publications

(64 citation statements)

References 22 publications

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“…A cohort study by Chan et al compared patients who continued long-term aspirin after admission with LGIB, versus those who discontinued it. The latter group had fewer rebleeding events, but significantly more cardiovascular events and deaths 104. This is in keeping with the cohort study by Oakland et al on a short interruption of antiplatelet therapy 112…”

Section: Drug Therapy Considerations In Acute Lgibsupporting

confidence: 85%

“…Predominantly the anticoagulant effect of direct oral anticoagulants (DOACs) is managed by simply withholding this medication. No drug can easily reverse the platelet dysfunction seen with antiplatelets, and these agents are mostly withheld in the acute setting of LGIB,6 despite evidence of poorer cardiovascular outcomes in the long term 104

We recommend interrupting warfarin therapy at presentation ( weak recommendation, low quality evidence ).

…”

Section: Drug Therapy Considerations In Acute Lgibmentioning

confidence: 99%

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Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

243

241

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Section: Drug Therapy Considerations In Acute Lgibsupporting

confidence: 85%

We recommend interrupting warfarin therapy at presentation ( weak recommendation, low quality evidence ).

…”

Section: Drug Therapy Considerations In Acute Lgibmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

243

241

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show abstract

“…Decisions regarding withholding antiplatelets in patients presenting with LGIB are difficult since continued antiplatelet use is associated with rebleeding,27 but withholding them may lead to increased cardiovascular morbidity 28. Guidelines recommend that patients receiving aspirin for secondary prevention of high-risk cardiovascular disease should not have this drug stopped 6.…”

Section: Discussionmentioning

confidence: 99%

Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

Oakland

Guy

Uberoi

et al. 2017

Gut

136

282

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“…Agreement rate: 88% Explanation Post-admission management is essential because of the association between discontinuation of antithrombogenic drugs and risk of thromboembolism or subsequent death [46][47][48][49][50][51]. A common recommendation among preexisting guidelines [34,[52][53][54][55][56][57] is that drugs should be discontinued after dialogue and in close collaboration with experts in different fields such as hematologists, cardiologists, neurologists, and gastroenterologists.…”

Section: Quality Of Evidence: C Strength Of Recommendation: Probably mentioning

confidence: 99%

“…Retrospective cohort studies in patients with aspirinassociated acute lower GIB [46,49,51] have shown that the discontinuation of aspirin was associated with a significantly lower rate of rebleeding but also a significantly higher number of adverse cardiovascular events compared with the continuation and re-administration of aspirin [46]. A randomized controlled study of patients with aspirin-associated upper GI bleeding has also demonstrated increased risks of cardiovascular events and mortality after discontinuation of aspirin, suggesting the advantages of resuming aspirin early [51].…”

Section: Cq24: Should Anticoagulant Therapy Be Resumed After Temporarmentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Risks of Bleeding Recurrence and Cardiovascular Events With Continued Aspirin Use After Lower Gastrointestinal Hemorrhage

Abstract: Among aspirin users with a history of lower GI bleeding, continuation of aspirin is associated with an increased risk of recurrent lower GI bleeding, but reduced risk of serious cardiovascular events and death.

Cited by 64 publications

References 22 publications

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

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