Management of anticoagulation in patients with acute gastrointestinal bleeding

Franco Radaelli, Francesco Dentali, Alessandro Repici, Arnaldo Amato, Silvia Paggi, Emanuele Rondonotti, Jean Marc Dumonceau

Research output: Contribution to journalArticlepeer-review

Abstract

Acute gastrointestinal bleeding represents the most common adverse event associated with the use of oral anticoagulant therapy. Due to increasing prescription of anticoagulants worldwide, gastroenterologists are more and more called to deal with bleeding patients taking these medications. Their management is challenging because several issues have to be taken into account, such as the severity of bleeding, the intensity of anticoagulation, the patient's thrombotic risk and endoscopy findings. The recent introduction into the marketplace of new direct oral anticoagulants, for whom specific reversal agents are still lacking, further contributes to make the decision-making process even more demanding. Available evidence on this topic is limited and practice guidelines by gastroenterology societies only marginally address key issues for clinicians, including when and how to reverse coagulopathy, the optimal timing of endoscopy and when and how to resume anticoagulation thereafter. The present paper reviews the evidence in the literature and provides practical algorithms to support clinicians in the management of patients on anticoagulants who present with acute gastrointestinal bleeding.

Original languageEnglish
Pages (from-to)621-627
Number of pages7
JournalDigestive and Liver Disease
Volume47
Issue number8
DOIs
Publication statusPublished - Aug 1 2015

Keywords

  • Anticoagulation reversal
  • Gastrointestinal bleeding
  • Oral anticoagulants

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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