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GI bleeding and anticoagulation

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
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
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
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
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
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
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
Daniel L Raines, Kellen T Jex, Mark J Nicaud, Douglas G Adler
BACKGROUND AND AIMS: The source of gastrointestinal bleeding (GIB) 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 anti-platelet and/or anti-coagulant 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 GIB evaluation...
June 22, 2016: Gastrointestinal Endoscopy
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
Kang-Ling Wang, Pao-Hsien Chu, Cheng-Han Lee, Pei-Ying Pai, Pao-Yen Lin, Kou-Gi Shyu, Wei-Tien Chang, Kuan-Ming Chiu, Chien-Lung Huang, Chung-Yi Lee, Yen-Hung Lin, Chun-Chieh Wang, Hsueh-Wei Yen, Wei-Hsian Yin, Hung-I Yeh, Chern-En Chiang, Shing-Jong Lin, San-Jou Yeh
UNLABELLED: Deep vein thrombosis (DVT) is a potentially catastrophic condition because thrombosis, left untreated, can result in detrimental pulmonary embolism. Yet in the absence of thrombosis, anticoagulation increases the risk of bleeding. In the existing literature, knowledge about the epidemiology of DVT is primarily based on investigations among Caucasian populations. There has been little information available about the epidemiology of DVT in Taiwan, and it is generally believed that DVT is less common in Asian patients than in Caucasian patients...
January 2016: Acta Cardiol Sin
Youngjin Han, Yong-Pil Cho, Gi-Young Ko, Dong Wan Seo, Min-Ju Kim, Hyunwook Kwon, Hyangkyoung Kim, Tae-Won Kwon
The aim of this study was to determine the clinical outcomes of long-term anticoagulation therapy in patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) and to evaluate whether conservative treatment with anticoagulation therapy is a safe and effective treatment modality for these patients.In this single center, observational cohort study, data from a prospectively recruiting symptomatic SIDSMA registry, including demographics, risk factors of interest, clinical characteristics and outcomes, and initial and follow-up computed tomography angiography (CTA) findings, were analyzed retrospectively...
April 2016: Medicine (Baltimore)
Robert Baumbach, Siegbert Faiss, Wolfgang Cordruwisch, Carsten Schrader
Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification)...
April 2016: Deutsche Medizinische Wochenschrift
Asli Ormeci, Filiz Akyuz, Bulent Baran, Suut Gokturk, Tugrul Ormeci, Binnur Pinarbasi, Ozlem Mutluay Soyer, Sami Evirgen, Umit Akyuz, Cetin Karaca, Kadir Demir, Sabahattin Kaymakoglu, Fatih Besisik
AIM: To assess the clinical impact of capsule endoscopy (CE) in the long-term follow-up period in patients with obscure gastrointestinal bleeding (OGIB). METHODS: One hundred and forty-one patients who applied CE for OGIB between 2009 and 2012 were retrospectively analyzed, and this cohort was then questioned prospectively. Demographic data of the patients were determined via the presence of comorbid diseases, use of non-steroidal anti-inflammatory drugs anticoagulant-antiaggregant agents, previous diagnostic tests for bleeding episodes, CE findings, laboratory tests and outcomes...
April 10, 2016: World Journal of Gastrointestinal Endoscopy
Robin Paudel, Luis W Dominguez, Prerna Dogra, Saurav Suman, Simon Badin, Carrie Wasserman
BACKGROUND: Acquired hemophilia A (AHA) classically presents with spontaneous bleeding of mucosal sites, GI tract, and subcutaneous tissues, often leading to large hematomas and ecchymosis. Among documented cases, 50% are idiopathic and few have been associated with trauma or surgery. We present a case of life-threatening bleeding caused by AHA, following trauma and complicated by multiple venous thrombi. CASE REPORT: A 21-year-old man presented with multiple injuries secondary to trauma leading to extensive life-saving surgery...
April 4, 2016: American Journal of Case Reports
Naoyoshi Nagata, Ryota Niikura, Atsuo Yamada, Toshiyuki Sakurai, Takuro Shimbo, Yuka Kobayashi, Makoto Okamoto, Yuzo Mitsuno, Keiji Ogura, Yoshihiro Hirata, Kazuma Fujimoto, Junichi Akiyama, Naomi Uemura, Kazuhiko Koike
BACKGROUND: Middle gastrointestinal bleeding (MGIB) risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs), and whether PPI use affects the interactions between MGIB and antithrombotic drugs...
2016: PloS One
Tanya R Riley, Mary L Gauthier-Lewis, Chelsea K Sanchez, Treavor T Riley
OBJECTIVE: To determine the incidence and severity of bleeding events requiring hospitalization among patients with atrial fibrillation (AF) receiving anticoagulants (dabigatran or warfarin) or antiplatelet agents (eg, aspirin and clopidogrel). METHODS: This was a single-center, retrospective cohort study involving 1494 patients with AF hospitalized from November 1, 2010, to November 1, 2011, with prior warfarin, dabigatran, or antiplatelet therapy. RESULTS: Overall bleeding events in the dabigatran group compared to the warfarin group were 24% and 12%, respectively (P = ...
March 7, 2016: Journal of Pharmacy Practice
Esa Y H Chen, Basia Diug, J Simon Bell, Kevin P Mc Namara, Michael J Dooley, Carl M Kirkpatrick, John J McNeil, Gillian E Caughey, Jenni Ilomäki
OBJECTIVES: The objective of our study was to describe spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. METHODS: Data were sourced from the Australian Therapeutic Goods Administration (TGA) Database of Adverse Event Notifications between June 2009 and May 2014. Records of haemorrhagic adverse events in which rivaroxaban or dabigatran was considered as a potential cause were analysed. RESULTS: There were 240 haemorrhagic adverse events associated with rivaroxaban and 504 associated with dabigatran...
February 2016: Therapeutic Advances in Drug Safety
N A Novikova, A N Volovchenko, V I Oldakovsky
Non-valvular atrial fibrillation is the most common cardiac source of emboli and cardioembolic stroke. Anticoagulants are recommended for preventing stroke in patients with non-valvular atrial fibrillation. Warfarin reduces the risk of stroke in patients with AF by approximately two-thirds. Several novel anticoagulants that can overcome the limitations of warfarin have been introduced in the market or are under development. The NOACs are at least as effective as warfarin for stroke prevention in AF. Bleeding complications, including gastrointestinal bleeding, are common complication of anticoagulant treatment...
2015: Experimental & Clinical Gastroenterology
Matthew W Sherwood, Christopher C Nessel, Anne S Hellkamp, Kenneth W Mahaffey, Jonathan P Piccini, Eun-Young Suh, Richard C Becker, Daniel E Singer, Jonathan L Halperin, Graeme J Hankey, Scott D Berkowitz, Keith A A Fox, Manesh R Patel
BACKGROUND: Gastrointestinal (GI) bleeding is a common complication of oral anticoagulation. OBJECTIVES: This study evaluated GI bleeding in patients who received at least 1 dose of the study drug in the on-treatment arm of the ROCKET AF (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial. METHODS: The primary outcome was adjudicated GI bleeding reported from first to last drug dose + 2 days...
December 1, 2015: Journal of the American College of Cardiology
Ángel Lanas
In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage...
September 2015: Gastroenterología y Hepatología
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