Gastrointestinal Bleeding in the Setting of Anticoagulation and Antiplatelet Therapy

Abstract

Predictors of bleeding on antiplatelets and/or antithrombotics therapy have been identified, but formulation and validation of a GI bleeding index for stratification of risk in individual patients is suggested. Reversal of anticoagulation in bleeding patients is associated with a low risk of thromboembolic events and permits the performance of diagnostic and therapeutic endoscopy. Proton-pump inhibitors and H. pylori eradication reduce the risk of rebleeding in those with acid-related disease.

Major bleeding events in stable outpatients with coronary, cerebrovascular or peripheral artery disease: findings from the FRENA registry

“…This finding needs to be confirmed by further studies, as this may be helpful for better targeting of therapy and also in devising effective new strategies for secondary prevention in these potentially highrisk patients. Finally, we did not find an increased incidence of major bleeding in patients on both anticoagulant and antiplatelet therapy as compared with those on antiplatelet agents alone, and this is in disagreement with the current literature [9][10][11]. We hypothesize that some patients perceived as being at high risk of bleeding in our study may have received less aggressive therapies, thus reducing their risk of bleeding.…”

Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

“…The risk of NVUGB associated with the use of antithrombotics depends on the active substance involved, the dose, duration of treatment, indication, and therapeutic combinations (double antiplatelet aggregation or combination of APAs with anticoagulants) (6). The concomitant use of other gastrotoxic agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), further increases the risk (7).…”

“…The concomitant use of other gastrotoxic agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), further increases the risk (7). Age, sex, co-morbidities and past medical history are other relevant factors to be included in risk evaluation (6). Prophylactic co-treatment with proton pump inhibitors (PPIs) is associated with a marked reduction in the risk of NVUGB in patients treated with APAs (while this protective ability does not seem to apply to anticoagulants) and should be considered when there is a high hemorrhagic risk (8,9).…”

Risk of gastrointestinal bleeding with direct oral anticoagulants: a systematic review and network meta-analysis

“…(66) Oesophagitis can predispose to minor GI bleeding especially in anticoagulated patients. (67) This potential effect should be considered by clinicians prescribing these medications and thorough documentation of GI side effects should be recorded in future studies on anticoagulants.…”