A practical guide on how to handle patients with bleeding events while on oral antithrombotic treatment

Gimbel, Marieke E.; Minderhoud, Scs; Berg, Jürrien M. ten

doi:10.1007/s12471-018-1117-1

Cited by 24 publications

(22 citation statements)

References 50 publications

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“…Enormous difficulties as to whether and when to restart medication are clearly evident in survivors [ 83 ]. In the large trials comparing new P2Y12 inhibitors to Clopidogrel, ICB was reported in only 0.3% of patients [ 8 , 9 ].…”

Section: Management Of Bleeding During Daptmentioning

confidence: 99%

“…Due to the scarce number of ICB events in DAPT trials, we can only presume that DAPT might be reinitiated after approximately 4 weeks, with aspirin plus clopidogrel, and continued until the minimum advised duration [ 5 , 83 ]. Clearly, reassessment of clinical status, need for DAPT (time from ischemic event/revascularization), and team discussion with neurologist/radiologist/cardiologist should guide the decision making process.…”

Section: Management Of Bleeding During Daptmentioning

confidence: 99%

See 1 more Smart Citation

Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

Tersalvi

Biasco

Cioffi

et al. 2020

JCM

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Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.

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Section: Management Of Bleeding During Daptmentioning

confidence: 99%

Section: Management Of Bleeding During Daptmentioning

confidence: 99%

Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

Tersalvi

Biasco

Cioffi

et al. 2020

JCM

View full text Add to dashboard Cite

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“…The specificity and sensitivity of the Technetium-99 RBC scan is 85% and 95% respectively in children and 60% and 9% respectively in adults. 18 These statistics elucidate the greater difficulty of establishing a diagnosis of MD in the adult population. The reduced sensitivity in adults is partly due to the reduced likelihood of an adult MD to express ectopic gastric mucosa.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Ischemia, a Rare Presentation of Meckel’s Diverticulum

Nessel

Kerndt

Shareef

et al. 2020

Spartan Medical Research Journal

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CONTEXT CONTEXT Meckel's diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases. METHODS METHODS This case involves an elderly male in his early 80's who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy. RESULTS RESULTS Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel's diverticulum. CONCLUSIONS CONCLUSIONS This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel's diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel's diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel's diverticula.

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“…Furthermore, in the case of emergency or urgent CABG, DAPT should be discontinued prematurely 11 . The discontinuation of DAPT might increase the risk of a thrombotic event 12 . However, delay in CABG had also been shown to associate with poor clinical outcome and increased risk of mortality 13 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: a systematic review and meta-analysis

et al. 2020

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Background: There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). Moreover, the evidence of previous studies about this topic remained inconclusive. This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG. Methods: A meta-analysis was conducted during March to October 2019. Searches were carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor covariate in our present study was DAPT (clopidogrel or ticagrelor), and the outcome measure was the risk of major bleeding. Sub-group analysis was also performed, where data were classified into pre- and post-CABG. Furthermore, to determine the correlation and effect estimation, data were analyzed using fixed or random effect model. Results: A total of 13 studies consisting 34,015 patients treated with clopidogrel and 32,661 patients treated with ticagrelor was included in our study. Our pooled calculation revealed that the incidence of major bleeding was not different significantly between clopidogrel and ticagrelor. In pre- and post-CABG sub-groups, our results also found no significant difference in major bleeding incidence between clopidogrel and ticagrelor groups. Conclusions: Our meta-analysis clarifies that clopidogrel, compared to ticagrelor, or vice versa, is not associated with the risk of major bleeding in ACS patients treated with CABG.

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A practical guide on how to handle patients with bleeding events while on oral antithrombotic treatment

Cited by 24 publications

References 50 publications

Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

Myocardial Ischemia, a Rare Presentation of Meckel’s Diverticulum

Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: a systematic review and meta-analysis

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