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GI bleeding and anticoagulation

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https://www.readbyqxmd.com/read/28588761/apixaban-concomitant-medicines-and-spontaneous-reports-of-haemorrhagic-events
#1
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
#2
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
#3
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
#4
Chris Klonaris, Nikolaos Patelis, Athanasios Katsargyris, Dimitrios Athanasiadis, Andreas Alexandrou, Theodoros Liakakos
OBJECTIVE: The aim of this case series is to report the results of our centre in the surgical treatment of infected abdominal aortic grafts using the neo-aortoiliac system (NAIS) procedure. PATIENTS AND METHODS: Four male and two female patients underwent a NAIS repair after endovascular (n=3), open (n=2) or combined surgery (n=1) in our centre. Mean age was 73±5.2 years. Graft infection was diagnosed by computed tomography angiography (CTA) and only in two cases further imaging was necessary...
May 8, 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
#5
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-systematic-review-and-meta-analysis
#6
Corey S Miller, Alastair Dorreen, Myriam Martel, Thao Huynh, Alan N Barkun
BACKGROUND AND AIMS: Non-vitamin K antagonist oral anticoagulants (NOACs) are convenient and effective in prevention and treatment of venous thromboembolism and prevention of stroke in patients with atrial fibrillation. However, these drugs have been associated with 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 to conventional anticoagulants for approved indications...
April 27, 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
#7
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
#8
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...
February 14, 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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
(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
#15
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
#16
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...
May 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
#17
REVIEW
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
#18
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 non-valvular atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015...
April 2017: Gastroenterology
https://www.readbyqxmd.com/read/28024166/east-asian-perspective-on-the-interaction-between-proton-pump-inhibitors-and-clopidogrel
#19
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 acid-related disorders including gastroesophageal reflux disease. They are also co-prescribed with oral anticoagulant agents and with dual-antiplatelet therapy for the treatment and prevention of gastrointestinal bleeding. Clopidogrel belongs to the drug class of thienopyridines and is currently the most widely prescribed oral anticoagulant agent either alone or in combination with aspirin...
June 2017: 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
#20
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...
February 28, 2017: Thrombosis and Haemostasis
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