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Gastrointestinal bleeding in the setting of anticoagulation and antiplatelet therapy

Show simple item record Barada K. Abdul-Baki H. El Hajj I.I. Hashash J.G. Green P.H.
dc.contributor.editor Jan-2009 2017-10-05T15:39:25Z 2017-10-05T15:39:25Z 2009
dc.identifier 10.1097/MCG.0b013e31811edd13
dc.identifier.issn 01920790
dc.description.abstract GOAL: To review the literature on the significance, risk factors, and management of occult and gross gastrointestinal (GI) bleeding in patients on antiplatelets and-or anticoagulants. STUDY: Relevant original and review articles and their bibliographies were analyzed. Estimates of risks and therapeutic outcomes were obtained from randomized trials, whereas risk factor identification was gathered from cross-control and prospective cohort studies. RESULTS: Antiplatelets and anticoagulants do not diminish the positive predictive value of fecal occult blood testing to find GI pathology. They increase the risk of gross GI bleeding, and predictors of hemorrhage include history of GI bleeding or ulcer disease, higher intensity of anticoagulation, combination therapy, and presence of comorbid conditions. A bleeding site is identified in most patients with peptic ulcer being the most common. In case of significant bleeding, complete or partial reversal of anticoagulation is undertaken on the basis of the balance of risks between bleeding and thromboembolic events. Early endoscopy can reveal lesions requiring endoscopic hemostasis, which can be performed in the setting of low-intensity anticoagulation. In patients with history of peptic disease or bleeding from an acid-related lesion, proton-pump inhibitors and Helicobacter pylori eradication reduce the risk of upper GI bleeding even when antiplatelet therapy is continued. CONCLUSIONS: 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. © 2009 Lippincott Williams and Wilkins, Inc.
dc.format.extent Pages: (5-12)
dc.language English
dc.publisher PHILADELPHIA
dc.relation.ispartof Publication Name: Journal of Clinical Gastroenterology; Publication Year: 2009; Volume: 43; no. 1; Pages: (5-12);
dc.source Scopus
dc.title Gastrointestinal bleeding in the setting of anticoagulation and antiplatelet therapy
dc.type Review
dc.contributor.affiliation Barada, K., Department of Internal Medicine, American University of Beirut, Lebanon, Gastroenterology Division, Internal Medicine Department, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon
dc.contributor.affiliation Abdul-Baki, H., Department of Internal Medicine, American University of Beirut, Lebanon
dc.contributor.affiliation El Hajj, I.I., Department of Internal Medicine, American University of Beirut, Lebanon
dc.contributor.affiliation Hashash, J.G., Department of Internal Medicine, American University of Beirut, Lebanon
dc.contributor.affiliation Green, P.H., Division of Gastroenterology, Columbia University College of Physicians and Surgeons, New York, NY, United States
dc.contributor.authorAddress Barada, K.; Gastroenterology Division, Internal Medicine Department, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Barada, K
dc.contributor.authorInitials Abdul-Baki, H
dc.contributor.authorInitials El Hajj, II
dc.contributor.authorInitials Hashash, JG
dc.contributor.authorInitials Green, PH
dc.contributor.authorReprintAddress Barada, K (reprint author), Amer Univ Beirut, Med Ctr, Dept Internal Med, Div Gastroenterol, POB 11-0236, Beirut 11072020, Lebanon.
dc.contributor.authorUniversity American University of Beirut Medical Center
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dc.description.citedCount 13
dc.description.citedTotWOSCount 20
dc.description.citedWOSCount 19
dc.format.extentCount 8
dc.identifier.coden JCGAD
dc.identifier.pubmedID 18607297
dc.identifier.scopusID 67651180738
dc.publisher.address 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA
dc.relation.ispartOfISOAbbr J. Clin. Gastroenterol.
dc.relation.ispartOfIssue 1
dc.relation.ispartofPubTitle Journal of Clinical Gastroenterology
dc.relation.ispartofPubTitleAbbr J. Clin. Gastroenterol.
dc.relation.ispartOfVolume 43
dc.source.ID WOS:000262057900003
dc.type.publication Journal
dc.subject.otherAuthKeyword Anticoagulation
dc.subject.otherAuthKeyword Antiplatelet
dc.subject.otherAuthKeyword Gastrointestinal bleeding
dc.subject.otherChemCAS acetylsalicylic acid, 493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1
dc.subject.otherChemCAS blood clotting factor 7, 9001-25-6
dc.subject.otherChemCAS clopidogrel, 113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8
dc.subject.otherChemCAS heparin, 37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5
dc.subject.otherChemCAS omeprazole, 73590-58-6, 95510-70-6
dc.subject.otherChemCAS phytomenadione, 11104-38-4, 84-80-0
dc.subject.otherChemCAS protamine, 11061-43-1, 9007-31-2, 9012-00-4
dc.subject.otherChemCAS prothrombin complex, 37224-63-8
dc.subject.otherChemCAS ranitidine, 66357-35-5, 66357-59-3
dc.subject.otherChemCAS vitamin K group, 12001-79-5
dc.subject.otherChemCAS warfarin, 129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2
dc.subject.otherChemCAS Anticoagulants
dc.subject.otherChemCAS Platelet Aggregation Inhibitors
dc.subject.otherChemCAS Proton Pump Inhibitors
dc.subject.otherIndex acetylsalicylic acid
dc.subject.otherIndex anticoagulant agent
dc.subject.otherIndex antithrombocytic agent
dc.subject.otherIndex blood clotting factor 7
dc.subject.otherIndex clopidogrel
dc.subject.otherIndex corticosteroid
dc.subject.otherIndex fresh frozen plasma
dc.subject.otherIndex heparin
dc.subject.otherIndex low molecular weight heparin
dc.subject.otherIndex nonsteroid antiinflammatory agent
dc.subject.otherIndex omeprazole
dc.subject.otherIndex phytomenadione
dc.subject.otherIndex placebo
dc.subject.otherIndex protamine
dc.subject.otherIndex prothrombin complex
dc.subject.otherIndex proton pump inhibitor
dc.subject.otherIndex ranitidine
dc.subject.otherIndex vitamin K group
dc.subject.otherIndex warfarin
dc.subject.otherIndex anemia
dc.subject.otherIndex anticoagulation
dc.subject.otherIndex clinical trial
dc.subject.otherIndex colon cancer
dc.subject.otherIndex comorbidity
dc.subject.otherIndex digestive system ulcer
dc.subject.otherIndex drug half life
dc.subject.otherIndex drug mechanism
dc.subject.otherIndex drug megadose
dc.subject.otherIndex drug withdrawal
dc.subject.otherIndex endoscopy
dc.subject.otherIndex gastrointestinal hemorrhage
dc.subject.otherIndex heart atrium fibrillation
dc.subject.otherIndex hemostasis
dc.subject.otherIndex histopathology
dc.subject.otherIndex human
dc.subject.otherIndex iron deficiency
dc.subject.otherIndex iron deficiency anemia
dc.subject.otherIndex low drug dose
dc.subject.otherIndex medical literature
dc.subject.otherIndex occult blood test
dc.subject.otherIndex peptic ulcer
dc.subject.otherIndex priority journal
dc.subject.otherIndex prophylaxis
dc.subject.otherIndex review
dc.subject.otherIndex risk factor
dc.subject.otherIndex stroke
dc.subject.otherIndex thromboembolism
dc.subject.otherIndex treatment outcome
dc.subject.otherIndex upper gastrointestinal bleeding
dc.subject.otherIndex Anticoagulants
dc.subject.otherIndex Clinical Trials as Topic
dc.subject.otherIndex Endoscopy
dc.subject.otherIndex Gastrointestinal Hemorrhage
dc.subject.otherIndex Helicobacter Infections
dc.subject.otherIndex Helicobacter pylori
dc.subject.otherIndex Humans
dc.subject.otherIndex Platelet Aggregation Inhibitors
dc.subject.otherIndex Proton Pump Inhibitors
dc.subject.otherIndex Risk Factors
dc.subject.otherKeywordPlus LOW-DOSE ASPIRIN
dc.subject.otherKeywordPlus ELUTING STENT IMPLANTATION
dc.subject.otherKeywordPlus LONG-TERM ANTICOAGULATION
dc.subject.otherKeywordPlus PROTON PUMP INHIBITORS
dc.subject.otherKeywordPlus HIGH-RISK PATIENTS
dc.subject.otherKeywordPlus A
dc.subject.otherWOS Gastroenterology and Hepatology

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