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GI bleeding and anticoagulation

Yu Meng, FangGen Lu, Lin Shi, MeiChu Cheng, Jie Zhang
RATIONALE: The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa. PATIENT CONCERNS: We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection. DIAGNOSES: The patient was diagnosed with nephrotic syndrome with pulmonary embolism. INTERVENTIONS: He was treated with anticoagulants and suffered from acute major GI bleeding during the treatment...
March 2018: Medicine (Baltimore)
Young Hwan Park, Won Seok Choi, Gi Won Choi, Hak Jun Kim
BACKGROUND: Although intracompartmental bleeding is one cause of traumatic compartment syndrome, no previous studies have defined the role of hemostatic stability in the development of traumatic compartment syndrome. Therefore, to investigate this issue, we identified the relationship between antiplatelet/anticoagulant medications and the development of traumatic foot compartment syndrome. In addition, as a possible predictor of compartment syndrome, we evaluated the utility of blood-clotting tests in the prediction of traumatic foot compartment syndrome...
March 1, 2018: Foot & Ankle International
Tawseef Dar, Bharat Yarlagadda, James Vacek, Buddhadeb Dawn, Dhanunjaya Lakkireddy
Background: Bleeding complications especially gastrointestinal bleeding remains a major challenge associated with oral anticoagulation therapy (OAT) and often leads clinicians to withdraw oral anticoagulation therapy (OAT) . This exposes patients to risk of stroke and systemic thromboembolism (STE). Novel oral anticoagulants (NOACs) have proved no better when it comes to bleeding events and in fact studies have shown that overall NOACs are associated with higher incidence of gastrointestinal (GI) bleeding compared to warfarin ...
December 2017: Journal of Atrial Fibrillation
Simone Y Loo, Janie Coulombe, Sophie Dell'Aniello, James M Brophy, Samy Suissa, Christel Renoux
OBJECTIVES: To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD). DESIGN: Population-based matched cohort study. SETTING: Over 670 primary care practices in the UK, contributing to the Clinical Practice Research Datalink. PARTICIPANTS: Up to 6818 adult patients newly treated with NOACs between 2011 and 2016, matched 1:1 to new users of VKAs on age, sex and high-dimensional propensity score...
January 24, 2018: BMJ Open
Craig I Coleman, Tatsiana Vaitsiakhovich, Elaine Nguyen, Erin R Weeda, Nitesh A Sood, Thomas J Bunz, Bernhard Schaefer, Anna-Katharina Meinecke, Daniel Eriksson
BACKGROUND: Schemas to identify bleeding-related hospitalizations in claims data differ in billing codes used and coding positions allowed. We assessed agreement across bleeding-related hospitalization coding schemas for claims analyses of nonvalvular atrial fibrillation (NVAF) patients on oral anticoagulation (OAC). HYPOTHESIS: We hypothesized that prior coding schemas used to identify bleeding-related hospitalizations in claim database studies would provide varying levels of agreement in incidence rates...
January 23, 2018: Clinical Cardiology
Zubair Khan, Umar Darr, Anas Renno, Abhinav Tiwari, Aijaz Sofi, Ali Nawras
Symptomatic primary (amyloid light-chain or AL) amyloidosis of the gastrointestinal (GI) tract is very rare. Most of the patients with symptomatic involvement of the GI tract present with altered motility, malabsorption, or bleeding. We report a case of gastric and colonic amyloidosis on anticoagulation presenting with massive upper and lower GI bleeding. A 67-year-old lady known to have multiple myeloma and AL amyloidosis on rivaroxaban presented with massive upper GI bleeding. Esophagogastroduodenoscopy showed a mass lesion (3 × 7 cm) located along the greater curvature in the body/antrum with active bleeding...
September 2017: Case Reports in Gastroenterology
Andrew S Tseng, J William Schleifer, Win-Kuang Shen, Robert McBane, Sunil Mankad, Heidi Esser, Darko Vucicevic, Fadi E Shamoun
BACKGROUND: Patients with heart failure (HF) have increased risk for thromboembolic events. Real-world incidences of efficacy and safety outcomes of direct oral anticoagulants (DOACs) in patients with left ventricular systolic dysfunction (LVSD) are of growing clinical interest. HYPOTHESIS: Real-world efficacy and safety outcomes of DOACs in patients with LVSD will be similar to those of LVSD or HF subgroups in the RE-LY, ROCKET-AF, and ARISTOTLE trials. METHODS: We performed a retrospective review of adult patients with LVSD (left ventricular ejection fraction ≤40%) on DOAC therapy between 2010 and 2016...
December 16, 2017: Clinical Cardiology
Yingmei Tang, Sheng Zheng, Jinhui Yang, Weimin Bao, Lihong Yang, Yingchun Li, Ying Xu, Jing Yang, Yuyun Tong, Jinhang Gao, Chengwei Tang
Transjugular intrahepatic portosystemic shunting (TIPS) is an effective treatment modality for refractory variceal bleeding and ascites in patients with cirrhotic portal hypertension (CPH). Variceal rebleeding and shunt dysfunction are major post-TIPS morbidities. This study aimed to retrospectively evaluate the effectiveness and safety of use of concomitant variceal embolization and prophylactic antiplatelet/anticoagulative in patients with CPH undergoing TIPS. Between October 2006 and October 2011, 182 patients with CPH were retrospectively and consecutively hospitalized for elective TIPS with Fluency stenting...
December 2017: Medicine (Baltimore)
Elaine Y Yu, Prashant Chandrasekharan, Ran Berzon, Zhi Wei Tay, Xinyi Y Zhou, Amit P Khandhar, R Matthew Ferguson, Scott J Kemp, Bo Zheng, Patrick W Goodwill, Michael F Wendland, Kannan M Krishnan, Spencer Behr, Jonathan Carter, Steven M Conolly
Gastrointestinal (GI) bleeding causes more than 300 000 hospitalizations per year in the United States. Imaging plays a crucial role in accurately locating the source of the bleed for timely intervention. Magnetic particle imaging (MPI) is an emerging clinically translatable imaging modality that images superparamagnetic iron-oxide (SPIO) tracers with extraordinary contrast and sensitivity. This linearly quantitative modality has zero background tissue signal and zero signal depth attenuation. MPI is also safe: there is zero ionizing radiation exposure to the patient and clinically approved tracers can be used with MPI...
December 26, 2017: ACS Nano
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 anticoagulants. 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 anticoagulants for the first detection of non-neoplastic PVT from 2003 to 2015 in Italy...
October 21, 2017: Clinical Gastroenterology and Hepatology
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
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
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
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)...
October 2017: Thrombosis Research
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
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
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
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...
November 2017: Clinical Endoscopy
Akira Shimomura, Naoyoshi Nagata, Takuro Shimbo, Toshiyuki Sakurai, Shiori Moriyasu, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Naomi Uemura
BACKGROUND AND AIM: The study developed a predictive model of long-term gastrointestinal (GI) bleeding risk in patients receiving oral anticoagulants and compared it with the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratios, Elderly, Drugs/alcohol concomitantly) score. METHODS: The study periodically followed a cohort of 508 patients taking oral anticoagulants (66 direct oral anticoagulants users and 442 warfarin users)...
January 2018: Journal of Gastroenterology and Hepatology
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
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