TY - JOUR
T1 - Management of anticoagulation in patients with acute gastrointestinal bleeding
AU - Radaelli, Franco
AU - Dentali, Francesco
AU - Repici, Alessandro
AU - Amato, Arnaldo
AU - Paggi, Silvia
AU - Rondonotti, Emanuele
AU - Dumonceau, Jean Marc
PY - 2015/8/1
Y1 - 2015/8/1
N2 - 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.
AB - 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.
KW - Anticoagulation reversal
KW - Gastrointestinal bleeding
KW - Oral anticoagulants
UR - http://www.scopus.com/inward/record.url?scp=84946153534&partnerID=8YFLogxK
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U2 - 10.1016/j.dld.2015.03.029
DO - 10.1016/j.dld.2015.03.029
M3 - Article
C2 - 25935464
AN - SCOPUS:84946153534
VL - 47
SP - 621
EP - 627
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 8
ER -