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GI bleeding and anticoagulation

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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
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/28148539/dtb-select-2-february-2017
#4
(no author information available yet)
MHRA clarifies spironolactone advice ● Statin dosing: morning or evening? ● PPI use and risk of community-acquired pneumonia ● Non-inferiority trials: caution needed ● CV safety of celecoxib? ● ADRs and emergency department visits ● Study questions use of duloxetine in stress incontinence ● New oral anticoagulants: more on GI bleeding risk.
February 2017: Drug and Therapeutics Bulletin
https://www.readbyqxmd.com/read/28106053/risk-of-gastrointestinal-bleeding-among-dabigatran-users-a-self-controlled-case-series-analysis
#5
Wenze Tang, Hsien-Yen Chang, Meijia Zhou, Sonal Singh
This article aims to evaluate the real world risk of gastrointestinal bleeding among users naïve to dabigatran. We adopted a self-controlled case series design. We sampled 1215 eligible adult participants who were continuous insured users between July 1, 2010 and March 31, 2012 with use of dabigatran and at least one gastrointestinal bleeding episode. We used a conditional Poisson regression to estimate incidence rate ratios. The population consisted of 64.69% of male and 60.25% patients equal to or greater than age 65 at start of observation...
January 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28091770/relevance-of-surgery-in-patients-with-non-variceal-upper-gastrointestinal-bleeding
#6
S Dango, T Beißbarth, E Weiss, A Seif Amir Hosseini, D Raddatz, V Ellenrieder, J Lotz, B M Ghadimi, A Beham
INTRODUCTION: Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention...
January 14, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28056795/bleeding-outcomes-associated-with-rivaroxaban-and-dabigatran-in-patients-treated-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#7
Pravesh Kumar Bundhun, Mohammad Zafooruddin Sani Soogund, Abhishek Rishikesh Teeluck, Manish Pursun, Akash Bhurtu, Wei-Qiang Huang
BACKGROUND: Warfarin is commonly used as a secondary prevention of stroke in patients with atrial fibrillation (AF). However, limitations have been observed even with the use of this medication. Recently, several newer direct oral anticoagulants (DOACs) have been approved for use by the food and drug administrations. Unfortunately, these newer drugs have seldom been compared directly with each other. Therefore, this study aimed to compare the bleeding events associated with rivaroxaban and dabigatran in patients treated for non-valvular AF...
January 6, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28043907/gastrointestinal-safety-of-direct-oral-anticoagulants-a-large-population-based-study
#8
Neena S Abraham, Peter A Noseworthy, Xiaoxi Yao, Lindsey R Sangaralingham, Nilay D Shah
BACKGROUND & AIMS: Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS: We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with nonvalve atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/28024166/an-east-asian-perspective-on-the-interaction-between-proton-pump-inhibitors-and-clopidogrel
#9
Duowu Zou, Khean-Lee Goh
Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia-Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for ARDs (Acid Related Disorders) including gastroesophageal reflux disease (GERD). They are also co-prescribed with oral anticoagulant agents (OAAs)and with dual-antiplatelet therapy (DAPT) for the treatment and prevention of gastrointestinal (GI) bleeding. Clopidogrel belongs to the drug class of thienopyridines, and is currently the most widely prescribed OAA either alone or in combination with aspirin...
December 26, 2016: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28004062/optimal-timing-of-vitamin-k-antagonist-resumption-after-upper-gastrointestinal-bleeding-a-risk-modelling-analysis
#10
Ammar Majeed, Niklas Wallvik, Joakim Eriksson, Jonas Höijer, Matteo Bottai, Margareta Holmström, Sam Schulman
The optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the 'total risk', based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption...
22, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27988509/rivaroxaban-induced-gastrointestinal-bleeding-presenting-as-acute-colon-obstruction
#11
Merav Cohen, Hadar Nevo, Dan Hershko, Alexander Becker
Rivaroxaban is a member of the novel target-specific oral anticoagulants (TSOACs) family of drugs recently approved for the prevention and treatment of venous thromboembolism events. A major drawback of the drug is its potential for causing severe hemorrhagic events, which may be difficult to treat in an emergency setting due to lack of effective antidote. Here, we describe a case of acute gastrointestinal (GI) hemorrhage leading to complete colon obstruction in a patient treated with rivaroxaban. Summary and Key Messages: The case presented here demonstrates a chain of events originating from an unprovoked intramural bleeding in a patient using rivaroxaban, leading to an organized giant clot formation, and to complete colon obstruction...
December 15, 2016: Pharmacology
https://www.readbyqxmd.com/read/27785314/safety-of-deep-enteroscopy-and-capsule-endoscopy-in-lvad-patients-case-report-and-literature-review
#12
Wilson Tak-Yu Kwong, Michelle Pearlman, Denise Kalmaz
Patients with a left ventricular assist device (LVAD) have increased risk of gastrointestinal (GI) bleeding. They are prone to develop angiodysplasia of the small intestine, and have a higher risk of bleeding as these patients are all required to be on permanent therapeutic anticoagulation. Here we report a case of a critically ill 55-year-old male on pressors and inotropes with an LVAD, who successfully underwent an antegrade double balloon enteroscopy (DBE).
December 2015: Gastroenterology Research
https://www.readbyqxmd.com/read/27765728/major-gastrointestinal-bleeding-often-is-caused-by-occult-malignancy-in-patients-receiving-warfarin-or-dabigatran-to-prevent-stroke-and-systemic-embolism-from-atrial-fibrillation
#13
Kathryn F Flack, Jay Desai, Jennifer M Kolb, Prapti Chatterjee, Lars C Wallentin, Michael Ezekowitz, Salim Yusuf, Stuart Connolly, Paul Reilly, Martina Brueckmann, John Ilgenfritz, James Aisenberg
BACKGROUND & AIMS: Gastrointestinal (GI) bleeding in patients receiving anticoagulation agents can be caused by occult malignancies. We investigated the proportions and features of major GI bleeding (MGIB) events related to occult GI cancers in patients receiving anticoagulation therapy. METHODS: We analyzed data from the Randomized Evaluation of Long Term Anticoagulant Therapy study (conducted between December 2005 and March 2009 in 951 clinical centers in 44 countries worldwide), which compared the abilities of dabigatran vs warfarin to prevent stroke and systemic embolism in 18,113 patients with atrial fibrillation...
October 17, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27716968/special-considerations-for-therapeutic-choice-of-non-vitamin-k-antagonist-oral-anticoagulants-for-japanese-patients-with-nonvalvular-atrial-fibrillation
#14
Ken Okumura, Masatsugu Hori, Norio Tanahashi, A John Camm
Nonvalvular atrial fibrillation (AF) is a risk factor for stroke in elderly patients. Although warfarin has been used to prevent AF-associated stroke for more than 50 years, non-vitamin K antagonist oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban recently have been developed to overcome the disadvantages of warfarin. Based on the results of NOAC clinical trials, Savelieva and Camm made recommendations regarding selection of NOACs in patients with nonvalvular AF. Recent accumulating evidence indicates that NOACs work differently in Asian and non-Asian individuals...
October 7, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27605936/real-world-comparison-of-non-vitamin-k-antagonist-oral-anticoagulants-and-warfarin-in-asian-octogenarian-patients-with-atrial-fibrillation
#15
Chang Hee Kwon, Minsu Kim, Jun Kim, Gi-Byoung Nam, Kee-Joon Choi, You-Ho Kim
BACKGROUND: The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asian octogenarian atrial fibrillation (AF) patients have not been established in a real-world setting. We aimed to evaluate the efficacy and safety of NOACs and warfarin in Korean octogenarian patients. METHODS: A total of 293 consecutive patients aged ≥ 80 years with non-valvular AF who had taken either NOACs (148 cases, 50.5%) or warfarin (145 cases, 49...
July 2016: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/27594378/safety-and-efficacy-of-new-oral-anticoagulants-and-low-molecular-weight-heparins-compared-with-aspirin-in-patients-undergoing-total-knee-and-hip-replacements
#16
Johannes T H Nielen, Pieter C Dagnelie, Pieter J Emans, Nicole Veldhorst-Janssen, Arief Lalmohamed, Tjeerd-Pieter van Staa, Annelies E R C H Boonen, Bart J F van den Bemt, Frank de Vries
BACKGROUND: There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery. OBJECTIVE: This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement. METHODS: A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink...
September 4, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/27472258/atrial-fibrillation-and-chronic-kidney-disease-requiring-hemodialysis-does-warfarin-therapy-improve-the-risks-of-this-lethal-combination
#17
Lohit Garg, Charity Chen, David E Haines
INTRODUCTION: Warfarin therapy for stroke prevention is recommended for patients with AF, but its value in patients with chronic kidney disease on HD is unknown. METHODS: The anticoagulation regimens of patients with a prior history of AF hospitalized for initiation of chronic HD, and of patients receiving chronic HD who had a new diagnosis of AF between 2009 and 2012 were reviewed. Exclusions were renal transplant, peritoneal dialysis, rheumatic valve disease, prosthetic heart valve, GI bleeding, malignancy with chemotherapy in last 6months or still undergoing treatment, a history of AF ablation, a history of ICD implantation, or those receiving warfarin for non-AF indications...
November 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27344150/association-between-renal-function-and-bleeding-risk-for-dabigatran-after-switching-from-warfarin
#18
Roberto S Kalil, Peter J Kaboli, Xin Liu, Mary Vaughan-Sarrazin
BACKGROUND: There is a higher risk of gastrointestinal (GI) bleeding in patients treated with dabigatran versus warfarin. We analyzed the impact of renal function on the relative risk of bleeding in patients converted to dabigatran. METHODS: Patients aged ≥65 years who received anticoagulation with warfarin for a minimum of 6 months and subsequently converted to dabigatran or remained on warfarin were studied. Data sources included VA National Patient Care, and VA Decision Support System National Pharmacy and Laboratory...
2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27343413/pharmacologic-provocation-combined-with-endoscopy-in-refractory-cases-of-gi-bleeding
#19
Daniel L Raines, Kellen T Jex, Mark J Nicaud, Douglas G Adler
BACKGROUND AND AIMS: The source of GI bleeding may elude us despite exhaustive testing in some cases. Bleeding in these cases is often related to a vascular lesion that is discernible only when actively bleeding. The objective of this study was to determine the efficacy and safety of endoscopy combined with the administration of antiplatelet and/or anticoagulant agents to stimulate bleeding in order to define a source. METHODS: A retrospective review of a database of device-assisted enteroscopy (DAE) procedures was completed to identify cases in which provocation with antiplatelet or anticoagulant agents was used as part of a GI bleeding evaluation...
January 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27284411/elevated-c-reactive-protein-level-predicts-lower-gastrointestinal-tract-bleeding
#20
Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Yoshinori Shirai, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
Lower gastrointestinal (GI) bleeding can be caused by colorectal polyps or cancer. The aim of the present study was to identify blood test variables and medications that can predict lower GI bleeding, which would allow for appropriate colonoscopy. The medical records of patients who underwent colonoscopy from September 2014 to September 2015 were retrospectively analyzed. The selected patients included 278 men (mean age, 67.0±11.5 years) and 249 women (mean age, 69.6±12.0 years). The diagnosis, medications, and blood test variables were compared between patients with and without bleeding...
June 2016: Biomedical Reports
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