Management and outcome of gastrointestinal bleeding in patients taking oral anticoagulants or antiplatelet drugs

Pannach, Sven; Goetze, Julia; Marten, Sandra; Schreier, Thomas; Tittl, Luise; Beyer‐Westendorf, Jan

doi:10.1007/s00535-017-1320-7

Cited by 35 publications

(44 citation statements)

References 56 publications

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“…There was a larger proportion of DOAC prescription among patients with a lower GI location than among those with an upper GI lesion location. A similar distribution was reported by Pannach et al[ 7 ] and by post-hoc analyses in pivotal trials[ 13 , 14 ]. Several reasons are given: Incomplete absorption of DOAC across the GI mucosa and a potential for topical drug activity leading to relevant concentrations of active drug in the lower GI tract[ 15 ], non-absorbed active DOAC being excreted into the feces[ 16 ].…”

Section: Discussionsupporting

confidence: 87%

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Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Bouget¹,

Viglino²,

Yvetot³

et al. 2020

WJG

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BACKGROUND There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic. AIM To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events. METHODS Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified. RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations ( P = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use ( P = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy vs dual antiplatelet agents. CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%).

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Section: Discussionsupporting

confidence: 87%

“…Among patients undergoing GI investigations, a bleeding lesion was identified for 64.5%, which is higher than in other reports: 42%-44% in the prospective study by Pannach et al[ 7 ], 58.4% in the post-hoc study by Kolb et al[ 13 ] within the RELY study.…”

Section: Discussioncontrasting

confidence: 55%

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Bouget¹,

Viglino²,

Yvetot³

et al. 2020

WJG

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“…Although current antiplatelet agents are commonly used in clinical practice, their limitations still need to be addressed. The main severe and relatively common side effect of antiplatelet therapy is a higher risk of hemorrhage, for example, gastrointestinal bleeding and intracranial and intracerebral hemorrhage (12,13). Another limitation affecting the efficiency of many antiplatelet drugs is genetic differences in the ability to metabolize prodrugs, such as clopidogrel, acquired anaphylaxis (heparin and aspirin) and drug resistance (aspirin) (14,15).…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet Activity of Tussilagone via Inhibition of the GPVI Downstream Signaling Pathway in Platelets

et al. 2020

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Tussilagone is a sesquiterpenoid extracted from Tussilago farfara and is used as an oriental medicine for asthma and bronchitis. Although previous studies have shown that tussilagone has an inhibitory effect on platelet aggregation, no studies have been performed to investigate its precise effect on platelets, and the underlying mechanism remains unclear. In the present study, we showed that tussilagone inhibited platelet aggregation induced by collagen, thrombin and ADP, as well as platelet release induced by collagen and thrombin, in mice. Tussilagone decreased P-selectin expression and αIIbβ3 activation (JON/A binding) in activated platelets, which indicated that tussilagone inhibited platelet activation. Moreover, tussilagone suppressed platelet spreading on fibrinogen and clot retraction. The levels of phosphorylated Syk, PLCγ2, Akt, GSK3β, and MAPK (ERK1/2 and P38) and molecules associated with GPVI downstream signaling were downregulated in the presence of tussilagone. In addition, tussilagone prolonged the occlusion time in a mouse model of FeCl 3-induced carotid artery thrombosis and had no effect on mouse tail bleeding time. These results indicate that tussilagone inhibits platelet function in vitro and in vivo and that the underlying mechanism involves the Syk/PLCγ2-PKC/MAPK and PI3K-Akt-GSK3β signaling pathways downstream of GPVI. This research suggests that tussilagone is a potential candidate antiplatelet drug for the prevention of thrombosis.

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“…18 The Dresden NOAC registry also reported that patients receiving NOAC had a greater GI-bleeding risk, in particular in the lower GI tract, when compared with VKA recipients. 19 In contrast, a previous real-world study from Texas showed a smaller number of GI-bleeding events in patients taking NOAC than those receiving VKA; however, the number of patients treated with NOAC was small. 20 Consistent with our data, recent studies have demonstrated that cerebral haemorrhage occurred less often in patients on NOAC treatment compared with VKA.…”

Section: Discussionmentioning

confidence: 87%

SSRI co‐medication with NOAC or VKA does not increase hospitalisation for bleeding: A retrospective nationwide cohort study in Austria 2010‐2015

Sheikh

Mittlböck

Reichardt

et al. 2019

Int J Geriat Psychiatry

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Objectives Non‐vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) are used for the prophylaxis and treatment of thromboembolic events. A potential drug–drug interaction and increased bleeding events have been reported with co‐medication of selective serotonin receptor inhibitors (SSRIs) and VKA. The aim of this study was to investigate the bleeding risk of a coprescription of NOAC or VKA with SSRI. Methods Patients with prescription of NOAC or VKA and an antidepressant drug therapy (ADTx) were selected from the drug reimbursement database of 13 Austrian health insurance funds. For this cohort, hospital discharge diagnoses for gastrointestinal bleeding, cerebral haemorrhage, and bleeding anaemia between 2010 and 2015 were analysed. Results Data were available from 50 196 female and 31 308 male patients. Among these, 892 patients had 987 hospitalisations with bleeding events. The most frequent bleeding cases were gastrointestinal bleedings with 588 events (59.6%), followed by cerebral haemorrhage with 344 (34.8%), and bleeding anaemia with 55 events (5.6%), respectively. The risk of bleeding events was similar between SSRI and other ADTx, when combined with oral anticoagulants (p = 0.51). Concomitant treatment of patients with SSRI or other ADTx and NOAC was associated with an increased bleeding risk compared with cotreatment with VKA (1.21, 95% CI: 1.05‐1.40; p = 0.0097). Conclusion Co‐medication of SSRI with VKA or NOAC has little if any impact on hospital discharge diagnoses for bleeding events compared with cotreatment of those anticoagulants with other antidepressant medications.

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Management and outcome of gastrointestinal bleeding in patients taking oral anticoagulants or antiplatelet drugs

Abstract: Gastrointestinal bleeding in NOAC recipients is different from that seen with VKA or antiplatelet therapy and has a better short-term prognosis.

Cited by 35 publications

References 56 publications

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

Antiplatelet Activity of Tussilagone via Inhibition of the GPVI Downstream Signaling Pathway in Platelets

SSRI co‐medication with NOAC or VKA does not increase hospitalisation for bleeding: A retrospective nationwide cohort study in Austria 2010‐2015

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