No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

Zakko, Liam; Rustagi, Tarun; Douglas, Maura; Laine, Loren

doi:10.1016/j.cgh.2016.07.017

Cited by 77 publications

(54 citation statements)

References 26 publications

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“…[10] In a retrospective cohort study, rebreeding rate was similar after platelet transfusion but associated with high mortality. [26] Elective endoscopy For low-and high-risk procedure, aspirin can be continued, but it has to be stopped prior to ultrahigh-risk procedures [ Table 5].…”

Section: Stopping Aspirinmentioning

confidence: 99%

Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents

Pal

Tandan

Reddy

2019

Journal of Digestive Endoscopy

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The use of antiplatelet and antithrombotic agents has increased hand in hand with the number and complexity of endoscopic procedures. Hence, the endoscopists are often faced with considering endoscopy in patients on these agents. In this setting, to make informed decision, four key aspects are need to be considered. The type of antithrombotic or antiplatelet agent used and its characteristics, risk of thromboembolic events (which can lead to ischemic stroke or acute coronary syndrome, both of which carry high morbidity) due to withholding the drug, risk of bleeding (increases with invasiveness of procedure), and timing of procedure (elective or urgent) are the key factors to consider. We aim to discuss the risk of gastrointestinal bleed and endoscopic procedures on antiplatelet and antithrombotic agents focusing on Indian context based on recent Asia?pacific guidelines along with other existing guidelines.

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Section: Stopping Aspirinmentioning

confidence: 99%

Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents

Pal

Tandan

Reddy

2019

Journal of Digestive Endoscopy

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“…45 However, observational studies have failed to identify clinical benefit, and a cohort study with 408 patients showed significantly higher mortality with platelet transfusion (odds ratio 5.6, 1.5 to 27.1). 46 This finding led the recent Asia-Pacific guideline panel to suggest that platelet transfusions should not be used in patients taking antiplatelet agents who present with upper gastrointestinal bleeding. 6 Platelet dysfunction may also be present in patients on hemodialysis or those who have had cardiac bypass surgery.…”

Section: Management Of Patients Taking Antithrombotic Drugsmentioning

confidence: 99%

Management of acute upper gastrointestinal bleeding

Smith

2018

Clinical Pharmacist

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summarizing evidence for risk assessment, resuscitation, blood transfusion, medical and endoscopic therapy, and early post-endoscopic management. We will not review interventions for long term secondary prevention of bleeding, such as testing for and treating Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or maintenance antisecretory therapy. Upper gastrointestinal bleeding is managed by many clinicians across many specialties, including emergency room physicians, hospitalists, internists, gastroenterologists, surgeons, interventional radiologists, and hematologists. A variety of topics-including risk assessment, the threshold for blood transfusion, the timing of endoscopy, and medical and endoscopic therapies-have continued to evolve in recent years. In addition, it has become increasingly important and complex to determine the appropriate management of patients who need antithrombotic agents, with gastroenterological, cardiovascular, and hematological aspects needing to be considered. This article provides a comprehensive and evidence based summary of the assessment and management of patients with acute upper gastrointestinal bleeding, which is relevant to clinician specialists, academics, and clinical researchers. A summary of management is provided in the box.

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“…However, evidence supporting this originates from a pilot study of 14 patients receiving dual antiplatelets and undergoing urgent surgery (Thiele et al, 2012). In contrast, a case-control study of GIB (including 161 cases of LGIB) found that platelet transfusion did not improve clinical outcomes in patients receiving antiplatelet drugs (Zakko et al, 2016). These findings are consistent with an RCT of platelet transfusion in patients receiving antiplatelet drugs who presented with intracranial haemorrhage (PATCH trial), which also found that platelet transfusion may be associated with harm (Baharoglu et al, 2016).…”

Section: Platelet Transfusionmentioning

confidence: 99%

Advances in transfusion medicine: gastrointestinal bleeding

Oakland

Jairath

Murphy

2017

Transfusion Medicine

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Gastrointestinal bleeding is a common medical and surgical emergency and is the second most common indication for red blood cell (RBC) transfusion in the UK. Most transfusion guidelines recommend the use of restrictive blood transfusion in stable gastrointestinal bleeding. This review explores the evidence supporting this practice, including whether it is safe in lower as well as upper gastrointestinal bleeding, and the risks of restrictive transfusion in patients with cardiovascular disease. There is a lack of evidence supporting the use of platelet and fresh frozen plasma transfusion in gastrointestinal bleeding. The aim of this review is to serve as a practical guide to transfusion in stable gastrointestinal bleeding.

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No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

Cited by 77 publications

References 26 publications

Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents

Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents

Management of acute upper gastrointestinal bleeding

Advances in transfusion medicine: gastrointestinal bleeding

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