Restarting Anticoagulation and Outcomes After Major Gastrointestinal Bleeding in Atrial Fibrillation

Qureshi, Waqas; Mittal, Chetan; Patsias, Iani; Garikapati, Kiran; Kuchipudi, Aishwarya; Cheema, Gagandeep; Elbatta, Mohammad; Alirhayim, Zaid; Khalid, Fatima

doi:10.1016/j.amjcard.2013.10.044

Cited by 187 publications

(191 citation statements)

References 18 publications

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“…In another cohort study of AF patients experiencing a major gastrointestinal bleed in the Henry Ford Health System, Qureshi and colleagues reported warfarin discontinuation in 50.9% of patients. Those who restarted warfarin experienced no increased risk of recurrent gastrointestinal bleed and a substantially decreased risk of thromboembolism and death relative to those who discontinued therapy 13. The slightly lower rates of OAC discontinuation observed in ORBIT‐AF may be due to our inclusion of any major bleeding event meeting ISTH criteria, regardless of anatomical location.…”

Section: Discussionmentioning

confidence: 88%

Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF

O’Brien

Holmes

Thomas

et al. 2018

JAHA

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BackgroundOral anticoagulation (OAC) reduces stroke risk in atrial fibrillation, but bleeding is a frequent side effect. The decision to discontinue or modify medication regimens in response to a bleeding event may differ according to bleeding site and severity.Methods and ResultsWe used data from a large, national outpatient registry, ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation; 2010–2011), to evaluate event characteristics and OAC management following the first bleeding event occurring during follow‐up. Bleeding events were classified into 3 categories: (1) International Society of Thrombosis and Hemostasis major bleeding, (2) clinically relevant nonmajor bleeding requiring medical attention, and (3) nuisance bleeding not requiring medical attention (eg, bruising, hemorrhoidal bleeding). Of 9743 patients enrolled in ORBIT‐AF with follow‐up data, 510 (3.23/100 subject‐years) experienced a major bleed, 615 (3.90/100 subject‐years), experienced a clinically relevant nonmajor bleed, and 1558 (9.87/100 subject‐years) experienced a nuisance bleed, among first bleeds over 2 years. Nearly one third of patients (31.6%) discontinued OAC therapy following a major bleeding event, 12.7% following a clinically relevant nonmajor bleed, and 4.5% following a nuisance bleed. Compared with those who experienced a clinically relevant nonmajor or nuisance bleed, patients who experienced a major bleed were more likely to be black and female and to have a history of heart failure and stroke. Those who discontinued were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on OAC therapy.ConclusionsOverall, 1 in 3 patients who experienced a major bleed was no longer anticoagulated after the event. Those who discontinued OAC were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on OAC.

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Section: Discussionmentioning

confidence: 88%

Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF

O’Brien

Holmes

Thomas

et al. 2018

JAHA

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“…Lee et al proposed that sensitivity of the urease test in the bleeding episode could be increased to 74% or 73% if four biopsies from antrum or one biopsy from corpus, respectively, were done during upper endoscopy (82). Additionally, it has been also reported that early H. pylori eradication decreases the risk of complicated recurrent peptic ulcers (83).…”

Section: Post-procedural Carementioning

confidence: 99%

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

Cúrdia-Gonçalves¹,

Rosa²,

Cotter³

2016

Rev Esp Enferm Dig

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Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition and the most common medical emergency managed by gastroenterologists. Despite being one of the most antique medical problems, recent studies have been slowly changing the management of these patients, which should nowadays include not only initial resuscitation, but also risk stratification, pre-endoscopic therapy, endoscopy treatment, and post-procedure care. The aim of this paper is to review the extended approach to the patient with non-portal hypertension related UGIB.

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“…4 Hence, it is reasonable to defer antithrombotic resumption up till 3-7 days post-endoscopy for lower risk indications such as atrial fi brillation. 5,6 In high risk cases, or those associated with NOAC use, bridging with low molecular weight heparin, or as Dr Jolobe points out, switching to an alternate NOAC with a favourable bleeding profi le, e.g. apixaban or edoxaban, could be considered.…”

Section: Antithrombotic Resumption After Acute Upper Gastrointestinalmentioning

confidence: 99%

What Big Data Could Achieve in Scotland

Ngai

Adil

2017

Journal of the Royal College of Physicians of Edinburgh

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Restarting Anticoagulation and Outcomes After Major Gastrointestinal Bleeding in Atrial Fibrillation

Cited by 187 publications

References 18 publications

Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF

Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

What Big Data Could Achieve in Scotland

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