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GI bleeding and anticoagulation

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https://www.readbyqxmd.com/read/29066371/harmful-and-beneficial-effects-of-anti-coagulants-in-patients-with-cirrhosis-and-portal-vein-thrombosis
#1
Vincenzo La Mura, Simon Braham, Giulia Tosetti, Federica Branchi, Niccolò Bitto, Marco Moia, Anna Ludovica Fracanzani, Massimo Colombo, Armando Tripodi, Massimo Primignani
BACKGROUND & AIMS: Vitamin K antagonists (VKAs) promote recanalization of portal vein thrombosis (PVT) in patients with cirrhosis. However, the benefit of PVT recanalization might be offset by major and minor bleeding associated with use of anti-coagulants. We evaluated harmful and beneficial effects of VKA in patients with PVT and cirrhosis. METHODS: We performed a retrospective study of 63 consecutive patients with cirrhosis given anti-coagulants for a first detection of non-neoplastic PVT from 2003 to 2015 in Italy...
October 21, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28991879/risks-versus-benefits-of-anticoagulation-for-atrial-fibrillation-in-cirrhotic-patients
#2
Jonggi Choi, Junhwan Kim, Ju Hyun Shim, Minsu Kim, Gi-Byoung Nam
BACKGROUND & AIMS: To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF). METHODS: A total of 465 cirrhotic patients diagnosed with nonvalvular AF were retrospectively analyzed. We compared incidences of ischemic stroke and major bleeding events between the 2 groups and examined the factors predicting ischemic stroke or major bleeding events. RESULTS: Of 465 patients with AF, 113 (24...
October 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28874418/therapeutic-endoscopy-related-gi-bleeding-and-thromboembolic-events-in-patients-using-warfarin-or-direct-oral-anticoagulants-results-from-a-large-nationwide-database-analysis
#3
Naoyoshi Nagata, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Kazuhiro Watanabe, Junichi Akiyama, Naomi Uemura, Ryota Niikura
OBJECTIVE: To compare the risks of postendoscopy outcomes associated with warfarin with direct oral anticoagulants (DOACs), taking into account heparin bridging and various types of endoscopic procedures. DESIGN: Using the Japanese Diagnosis Procedure Combination database, we identified 16 977 patients who underwent 13 types of high-risk endoscopic procedures and took preoperative warfarin or DOACs from 2014 to 2015. One-to-one propensity score matching was performed to compare postendoscopy GI bleeding and thromboembolism between the warfarin and DOAC groups...
September 5, 2017: Gut
https://www.readbyqxmd.com/read/28874129/comparative-effectiveness-of-rivaroxaban-versus-warfarin-or-dabigatran-for-the-treatment-of-patients-with-non-valvular-atrial-fibrillation
#4
Faye L Norby, Lindsay G S Bengtson, Pamela L Lutsey, Lin Y Chen, Richard F MacLehose, Alanna M Chamberlain, Ian Rapson, Alvaro Alonso
BACKGROUND: Rivaroxaban is an oral anticoagulant approved in the US for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large real-world population. METHODS: We selected NVAF patients initiating oral anticoagulant use in 2010-2014 enrolled in MarketScan databases. Rivaroxaban users were matched with warfarin and dabigatran users by age, sex, enrolment date, anticoagulant initiation date, and high-dimensional propensity score...
September 6, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28820967/identifying-predictors-for-bleeding-in-hospitalized-cancer-patients-a-cohort-study
#5
Rushad Patell, Alejandra Gutierrez, Lisa Rybicki, Alok A Khorana
BACKGROUND: Bleeding and thrombosis are both major complications of hospitalization in cancer patients. Concern regarding bleeding risk may reduce compliance with thromboprophylaxis. We assessed incidence of major and clinically relevant non-major bleeding (MCRNMB) and identified risk factors associated with in-hospital bleeding risk in hospitalized cancer patients. METHODS: We conducted a retrospective cohort study of consecutive adults admitted to general oncology floor at Cleveland Clinic from 11/2012-12/2014 (n=3525)...
August 12, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28761577/bleeding-risk-related-to-upper-gastrointestinal-endoscopic-biopsy-in-patients-receiving-antithrombotic-therapy-a-multicenter-prospective-observational-study
#6
Takafumi Yuki, Shunji Ishihara, Kazuo Yashima, Koichiro Kawaguchi, Hirofumi Fujishiro, Youichi Miyaoka, Mika Yuki, Yoshinori Kushiyama, Akiko Yasugi, Michiko Shabana, Koichirou Furuta, Kiwamu Tanaka, Masaharu Koda, Tetsuro Hamamoto, Yuichiro Sasaki, Hisao Tanaka, Teiji Yoshimura, Yoshikazu Murawaki, Hajime Isomoto, Yoshikazu Kinoshita
BACKGROUND: Although antithrombotic agents are widely used for cardiac and cerebrovascular disease prevention, they increase the risk of gastrointestinal (GI) bleeding. OBJECTIVE: To examine GI bleeding risk in association with an esophagogastroduodenoscopy (EGD) biopsy performed in patients without cessation of antithrombotic therapy. METHODS: This study was prospectively conducted at 14 centers. EGD biopsies were performed in patients receiving antithrombotic agents without cessation, as well as age- and sex-matched controls not receiving antithrombotic therapy...
2017: Current Therapeutic Research, Clinical and Experimental
https://www.readbyqxmd.com/read/28754388/rationale-design-and-baseline-characteristics-of-participants-in-the-cardiovascular-outcomes-for-people-using-anticoagulation-strategies-compass-trial
#7
REVIEW
Jackie Bosch, John W Eikelboom, Stuart J Connolly, Nancy Cook Bruns, Vivian Lanius, Fei Yuan, Frank Misselwitz, Edmond Chen, Rafael Diaz, Marco Alings, Eva M Lonn, Petr Widimsky, Masatsugu Hori, Alvaro Avezum, Leopoldo S Piegas, Deepak L Bhatt, Kelley R H Branch, Jeffrey L Probstfield, Yan Liang, Lisheng Liu, Jun Zhu, Aldo P Maggioni, Patricio Lopez-Jaramillo, Martin O'Donnell, Keith A A Fox, Ajay Kakkar, Alexander N Parkhomenko, Georg Ertl, Stefan Störk, Katalin Keltai, Matyas Keltai, Lars Ryden, Gilles R Dagenais, Nana Pogosova, Antonio L Dans, Fernando Lanas, Patrick J Commerford, Christian Torp-Pedersen, Tomasz J Guzik, Peter B Verhamme, Dragos Vinereanu, Jae-Hyung Kim, Jong-Won Ha, Andrew M Tonkin, John D Varigos, Basil S Lewis, Camilo Felix, Khalid Yusoff, Philippe Gabriel Steg, Victor Aboyans, Kaj P Metsarinne, Sonia S Anand, Robert G Hart, Andre Lamy, Paul Moayyedi, Darryl P Leong, Mukul Sharma, Salim Yusuf
BACKGROUND: Long-term aspirin prevents vascular events but is only modestly effective. Rivaroxaban alone or in combination with aspirin might be more effective than aspirin alone for vascular prevention in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). Rivaroxaban as well as aspirin increase upper gastrointestinal (GI) bleeding and this might be prevented by proton pump inhibitor therapy. METHODS: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) is a double-blind superiority trial comparing rivaroxaban 2...
August 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28588761/apixaban-concomitant-medicines-and-spontaneous-reports-of-haemorrhagic-events
#8
Gillian E Caughey, Lisa M Kalisch Ellett, John D Barratt, Sepehr Shakib
INTRODUCTION: Little is known about the potential safety issues associated with apixaban in clinical practice and their reporting in spontaneous adverse event (SAE) databases. OBJECTIVE: To describe SAE reports associated with the oral anticoagulant apixaban from Australia, Canada and USA and to examine associated concomitant medicine use. METHODS: SAE report databases from Australia, Canada and the USA were examined for all reports of adverse events associated with apixaban and concomitant medicines from 1 January 2012 to 30 September 2014...
May 2017: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/28565729/combined-endoscopic-and-surgical-treatment-of-severe-gastrointestinal-bleeding-in-a-patient-with-heart-assist-device-under-therapeutic-anticoagulation
#9
Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot...
June 1, 2017: Clinical Endoscopy
https://www.readbyqxmd.com/read/28544091/a-new-predictive-model-for-acute-gastrointestinal-bleeding-in-patients-taking-oral-anticoagulants-a-cohort-study
#10
Akira Shimomura, Naoyoshi Nagata, Takuro Shimbo, Toshiyuki Sakurai, Shiori Moriyasu, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Naomi Uemura
BACKGROUND: We developed a predictive model of long-term gastrointestinal (GI) bleeding risk in patients receiving oral anticoagulants and compared it with the HAS-BLED score. METHODS: We periodically followed a cohort of 508 patients taking oral anticoagulants (66 direct oral anticoagulants users and 442 warfarin users). Absence of GI bleeding at an initial examination, and any subsequent GI bleeding, were confirmed endoscopically. The bleeding model was developed by multivariate survival analysis and evaluated by Harrell's c-index...
May 19, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28495536/neoaortoiliac-system-procedure-to-treat-infected-aortic-grafts
#11
Chris Klonaris, Nikolaos Patelis, Athanasios Katsargyris, Dimitrios Athanasiadis, Andreas Alexandrou, Theodoros Liakakos
BACKGROUND: The aim of this case series is to report the results of our center in the surgical treatment of infected abdominal aortic grafts using the neoaortoiliac system (NAIS) procedure. METHODS: Four male and 2 female patients underwent an NAIS repair after endovascular (n = 3), open (n = 2), or combined surgery (n = 1) in our center. Mean age was 73 ± 5.2 years. Graft infection was diagnosed by computed tomography angiography (CTA), and only in 2 cases further imaging was necessary...
October 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28484732/use-of-over-the-scope-clips-otsc-for-hemostasis-in-gastrointestinal-bleeding-in-patients-under-antithrombotic-therapy
#12
Regina Lamberts, Anna Koch, Christian Binner, Marcus Zachäus, Ingrid Knigge, Mark Bernhardt, Ulrich Halm
Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding...
May 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28458008/risk-of-gastrointestinal-bleeding-in-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-a%C3%A2-systematic%C3%A2-review-and-meta-analysis
#13
Corey S Miller, Alastair Dorreen, Myriam Martel, Thao Huynh, Alan N Barkun
BACKGROUND & AIMS: Non-vitamin K antagonist oral anticoagulants (NOACs) are convenient and effective in the prevention and treatment of venous thromboembolism and the prevention of stroke in patients with atrial fibrillation. However, these drugs have been associated with an increased risk of gastrointestinal (GI) bleeding. We conducted a systematic review and meta-analysis to determine the risk of GI bleeding in patients receiving these drugs. METHODS: We searched the EMBASE, Medline, Cochrane, and ISI Web of knowledge databases through January 2016 for randomized trials that compared NOACs with conventional anticoagulants for approved indications...
November 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28405330/middle-term-mortality-and-re-bleeding-after-initial-diverticular-bleeding-a-nationwide-study-of-365-mostly-elderly-french-patients
#14
Diane Lorenzo, Claire Gallois, Pierre Lahmek, Bruno Lesgourgues, Christine Champion, Claire Charpignon, Roger Faroux, Bruno Bour, André-Jean Remy, Chantal Naouri, Magali Picon, Eric Poncin, Gilles Macaigne, Jacques-Arnaud Seyrig, David Bernardini, Guy Bellaïche, Denis Grasset, Jean Henrion, Frédéric Heluwaert, René Piperaud, Gilbert Bordes, Francois Bourhis, Jean-Pierre Arpurt, Alexandre Pariente, Stéphane Nahon
BACKGROUND AND AIMS: The aim of this study was to determine the mortality and re-bleeding rates, and the risk factors involved, in a cohort of patients with previous diverticular bleeding (DB). METHODS: In 2007, data on 2462 patients with lower gastrointestinal (GI) bleeding were collected prospectively at several French hospitals. We studied the follow-up of patients with DB retrospectively. The following data were collected: age, mortality rates and re-bleeding rates, drug intake, surgery and comorbidities...
February 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28283237/duodenal-ulcers-are-a-major-cause-of-gastrointestinal-bleeding-after-cardiac-surgery
#15
Frances Krawiec, Andrew Maitland, Qiuli Duan, Peter Faris, Paul J Belletrutti, William D T Kent
OBJECTIVE: To determine the incidence of gastrointestinal (GI) bleeding in patients after cardiac surgery, assess the perioperative risk factors, and determine the type of GI tract pathology associated with bleeding events. METHODS: At a tertiary referral hospital, all cardiac surgery patients having a postoperative GI bleed from April 2002 to March 2012 were identified. To determine bleeding etiology, only patients requiring endoscopy were included in the analysis...
July 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28261770/what-is-the-clinical-yield-of-capsule-endoscopy-in-the-management-of-obscure-bleeding-in-emergency-service
#16
Muhammed Zübeyr Üçüncü, Süleyman Bademler, Mehmet İlhan, Ali Fuat Kaan Gök, Filiz Akyüz, Recep Güloğlu
BACKGROUND: The aim of this study was to investigate the efficacy of capsule endoscopy (CE) performed on patients who presented to emergency room with clinically evident gastrointestinal (GI) bleeding from unknown source and were hospitalized for follow-up. METHODS: Total of 38 patients who underwent CE and were followed-up for evaluation of clinically perceptible GI bleeding with no obvious etiology in Istanbul Medical Faculty emergency surgery department were included in the study...
January 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28244496/a-comparison-of-the-rate-of-gastrointestinal-bleeding-in-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-or-warfarin
#17
COMPARATIVE STUDY
David J Cangemi, Timothy Krill, Rick Weideman, Daisha J Cipher, Stuart J Spechler, Linda A Feagins
OBJECTIVES: Early reports suggested that the risk of gastrointestinal bleeding (GIB) was higher for patients on non-vitamin K antagonist oral anticoagulants (NOACs) than for those on warfarin. We compared the incidence of GIB in our patients on NOACs with those on warfarin. METHODS: We used our VA pharmacy database to identify patients taking NOACs (dabigatran, rivaroxaban, and apixaban) or warfarin between January 2011 and June 2015, and used the VistA system to identify those who were hospitalized for GIB...
May 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28224113/intensity-modulated-radiation-therapy-with-stereotactic-body-radiation-therapy-boost-for-unfavorable-prostate-cancer-a-report-on-3-year-toxicity
#18
Ima Paydar, Abigail Pepin, Robyn A Cyr, Joseph King, Thomas M Yung, Elizabeth G Bullock, Siyuan Lei, Andrew Satinsky, K William Harter, Simeng Suy, Anatoly Dritschilo, John H Lynch, Thomas P Kole, Sean P Collins
BACKGROUND: Recent data suggest that intensity-modulated radiation therapy (IMRT) plus brachytherapy boost for unfavorable prostate cancer provides improved biochemical relapse-free survival over IMRT alone. Stereotactic body radiation therapy (SBRT) may be a less invasive alternative to brachytherapy boost. Here, we report the 3-year gastrointestinal (GI) and genitourinary (GU) toxicities of IMRT plus SBRT boost. MATERIALS AND METHODS: Between March 2008 and September 2012, patients with prostate cancer were treated with robotic SBRT (19...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28182647/performance-analysis-of-a-machine-learning-flagging-system-used-to-identify-a-group-of-individuals-at-a-high-risk-for-colorectal-cancer
#19
Yaron Kinar, Pinchas Akiva, Eran Choman, Revital Kariv, Varda Shalev, Bernard Levin, Steven A Narod, Ran Goshen
Individuals with colorectal cancer (CRC) have a tendency to intestinal bleeding which may result in mild to severe iron deficiency anemia, but for many colon cancer patients hematological abnormalities are subtle. The fecal occult blood test (FOBT) is used as a pre-screening test whereby those with a positive FOBT are referred to colonscopy. We sought to determine if information contained in the complete blood count (CBC) report coud be processed automatically and used to predict the presence of occult colorectal cancer (CRC) in the setting of a large health services plan...
2017: PloS One
https://www.readbyqxmd.com/read/28148540/acute-lower-gi-bleeding-in-the-uk-patient-characteristics-interventions-and-outcomes-in-the-first-nationwide-audit
#20
Kathryn Oakland, Richard Guy, Raman Uberoi, Rachel Hogg, Neil Mortensen, Michael F Murphy, Vipul Jairath
OBJECTIVE: Lower GI bleeding (LGIB) is a common reason for emergency hospital admission, although there is paucity of data on presentations, interventions and outcomes. In this nationwide UK audit, we describe patient characteristics, interventions including endoscopy, radiology and surgery as well as clinical outcomes. DESIGN: Multicentre audit of adults presenting with LGIB to UK hospitals over 2 months in 2015. Consecutive cases were prospectively enrolled by clinical teams and followed for 28 days...
February 1, 2017: Gut
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