Gastrointestinal Bleeding and Anticoagulant or Antiplatelet Drugs

Abstract

Gastrointestinal (GI) bleeding is a frequently encountered and very serious problem in emergency room patients who are currently being treated with anticoagulant or antiplatelet medications. There is, however, a lack of clinical practice guidelines about how to respond to these situations. The goal of this study was to find published articles that contain specific information about how to safely adjust anticoagulant and antiplatelet therapy when GI bleeding occurs.The investigators initiated a global search on the PubMed and Google websites for published information about GI bleeding in the presence of anticoagulant or antiplatelet therapy. After eliminating duplicate entries, the medical articles that remained were screened to narrow the sets of articles to those that met specific criteria. Articles that most closely matched study criteria were analyzed in detail and compared to determine how many actual guidelines exist and are useful.We could provide only minimal information about appropriate therapeutic strategies because no articles provided sufficient specific advice about how to respond to situations involving acute GI bleeding and concurrent use of anticoagulant or antiplatelet drugs. Only 4 articles provided enough detail to be of any use in an emergency situation.Clinical practice guidelines and also clinical trials for GI hemorrhaging should be expanded to state in which situations the use of anticoagulant or antiplatelet drugs should be suspended and the medications should later be resumed, and they should state the level of risk for any particular action.

Gastrointestinal bleeding and the prevention of thromboembolism

“…If TNS > 5 low dose of Vitamin K can be given orally (1-5 mg) or intravenously (1-2.5 mg). [1,3,4] In the described situation, INR value has been in the therapeutic range [2,19]. This INR value does not require additional coagulation recovering actions, such as Vitamin K, PCC or FFP.…”

“…Based on literature sources, in cases of active and heavy bleeding, the usage of anticoagulants should be discontinued, except minimal rectal bleeding. [1,2] In case of this specific patient, bleeding has been active, with a decreasing amount of haemoglobin, consequently, warfarin has been discontinued, according to the recommendations of literature sources.…”

“…Early endoscopic intervention is the main measure to stop gastrointestinal bleeding, so this procedure should be organized immediately. [2] Anticoagulants users' blood coagulation, which is mainly reflected by the international normalized ratio (INR), can be over the therapeutic value, that is why it is important to measure INR during the patient preparation for the endoscopic procedure and to take additional means for restoring normal coagulation. According to ASGE practical guidelines, in cases when bleeding is active, but INR value fits in therapeutic range (< 2.5), it is not recommended to postpone endoscopic procedure in the purpose of restoring coagulation.…”

Clinical outcomes of non-variceal upper gastrointestinal bleeding and its relation to aspirin and anticoagulants.

“…On the one hand, any anticoagulant and antiplatelet treatment should be discontinued to help stopping the acute bleeding. On the other hand, discontinuing this type of therapy can significantly increase the risk for cardiovascular or cerebrovascular complications due to the underlying disease [44]. Regarding the medical history of the patients, being diabetic or hypertensive or cardiac patient was statistically significant (Table 3).…”

Upper gastrointestinal bleeding in Japanese patients with ischemic heart disease receiving vonoprazan or a proton pump inhibitor with multiple antithrombotic agents: A nationwide database study

“…Antiplatelet drugs can result in the development of ulcers and erosions in the GI tract, while anticoagulants may provoke bleeding from existing lesions [17]. Of note, the relative risk for UGIB increases by up to 10% in patients being treated with antiplatelet or anticoagulant therapies for the treatment or prevention of cardiovascular and cerebrovascular diseases [40], and the annual risk for upper GI bleeding occurring in such patients is 1.5%-4.5% [41][42][43]. In our study, patients had 1 or more risk factors for UGIB.…”