Gross Lower Gastrointestinal Bleeding in Patients on Anticoagulant and/or Antiplatelet Therapy

Hashash, Jana G.; Shamseddeen, Wael; Skoury, Assaad; Aoun, Nathalie; Barada, Kassem

doi:10.1097/mcg.0b013e318151f9d7

Cited by 24 publications

(13 citation statements)

References 32 publications

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“…by guest on May 11, 2018 http://circ.ahajournals.org/ Downloaded from with more severe bleeding (35.4% versus 55.1%, P=0.03) as defined by hemodynamic instability and the need for transfusion. 23 Our data extend this literature by quantifying the risk of UGIE, LGIE, and bleeding-related transfusions and hospitalizations associated with antiplatelets, and presents these data in the context of the way antiplatelet drugs are prescribed in this country, in dual and triple combinations, including ASA and anticoagulants.…”

Section: Discussionmentioning

confidence: 86%

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

et al. 2013

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Background-Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. Methods and Results-Veterans ≥60 years of age prescribed anticoagulant-antiplatelet, aspirin (ASA)-antiplatelet, ASAanticoagulant, or triple therapy (ie, TRIP, anticoagulant-antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008. Prescription-fill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-antiplatelet and anticoagulant-antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies.LGIE was 30% higher with anticoagulant-antiplatelet, and transfusion increased with ASA-anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-antiplatelet), 34 (ASA-anticoagulant), 67 (ASA-antiplatelet), and 45 (TRIP) patients. Conclusions-Among

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Section: Discussionmentioning

confidence: 86%

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

et al. 2013

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“…60 The most common causes of upper GI blood loss in these patients are peptic ulcer disease and erosive disease of the esophagus, stomach, and duodenum, 61 whereas diverticular bleeding seems to be the most common cause of lower GIB. 62,63 In 1 retrospective series of 52 patients, correction of the INR to 1.5 to 2.5 allowed successful endoscopic diagnosis and therapy at rates comparable with those achieved in nonanticoagulated patients. 4 In a recently reported large series in which 95% of patients had INRs between 1.3 and 2.7, endoscopic therapy achieved initial success in 94.7% (233/246) of patients by using a variety of hemostatic techniques including injection therapy, heater probe, and hemoclips.…”

Section: Efficacy Of Endoscopic Therapy In Patients Actively Taking Amentioning

confidence: 79%

Management of antithrombotic agents for endoscopic procedures

Anderson¹,

Ben–Menachem²,

Gan³

et al. 2009

Gastrointestinal Endoscopy

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299

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“…Owing to the small number of patients, it cannot be safely concluded that the medications had no asscoiation with lower GI bleeding. Nonetheless, care should be taken for the management of patients with lower GI bleeding when they are prescribed with NSAIDs and anticoagulants (21).…”

Section: Discussionmentioning

confidence: 99%

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

et al. 2016

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Abstract. 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. Logistic regression analysis was performed to determine the factors associated with lower GI bleeding. The presence of colorectal polyp and cancer was associated with lower GI bleeding (P=0.0044) with an odds ratio of 6.71 (P=0.0148). No lower GI bleeding was observed in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. The C-reactive protein (CRP) levels were significantly higher in patients with lower GI bleeding (P=0.0227). The Hb levels were lower in patients with lower GI bleeding, however this finding was not statistically significant (P>0.05). No blood test variable was associated with lower GI bleeding. Elevated CRP was associated with lower GI bleeding, while there was no association between the medications and lower GI bleeding. IntroductionLower gastrointestinal (GI) bleeding occurs if the bleeding source is located distally to the Treitz ligament (1). It can be caused by colorectal polyps, colorectal cancer (CRC), or colonic diverticulum (2) and can be lethal in some patients, particularly the elderly (3). It is diagnosed and treated with colonoscopy (4,5).Lower GI bleeding is usually chronic and stops spontaneously (6). The identification of the bleeding site is important in its management (7). Lower GI bleeding is usually diagnosed with screening colonoscopy. If the risk factors are known, it is be possible to perform colonoscopy for such patients. The risk factors of patients hospitalized for severe lower GI bleeding include medication with non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (8). It is not clear whether NSAIDs and anticoagulants are related to lower GI bleeding diagnosed using screening colonoscopy. Corticosteroids, used in the treatment of autoimmune disease such as rheumatoid arthritis (9), are associated with bleeding from peptic ulcer (1). However, whether corticosteroids are associated with lower GI bleeding remains to be determined.Blood test variables are easy to obtain and quantitate. These variables can be useful in distinguishing upper from lower GI bleeding, which can aid the clinical diagnosis (10).In this study, we analyzed the diagnosis of screening colonoscopy and compared medication intake (i.e., NSAIDs, corticosteroids, and anticoagulants) between patients with or without lower GI bleeding. Blood test variables were also analyzed. Materials and methodsEthics statement. The National Hospital Organization Shi...

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Gross Lower Gastrointestinal Bleeding in Patients on Anticoagulant and/or Antiplatelet Therapy

Abstract: Use of antiplatelets/anticoagulant drugs is an independent predictor of severe LGIB and is associated with adverse outcomes. Colonoscopy is required in patients who bleed while using such drugs.

Cited by 24 publications

References 32 publications

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

Management of antithrombotic agents for endoscopic procedures

Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding

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