Effect of gastroprotective agents on upper gastrointestinal bleeding in patients receiving direct oral anticoagulants

2018 ◽  
Vol 53 (12) ◽  
pp. 1490-1495 ◽  
Author(s):  
Sung Hee Youn ◽  
Hyun Lim ◽  
Yeonmi Ju ◽  
Jae Seung Soh ◽  
Ji Won Park ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Upper Gastrointestinal

scholarly journals Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Gut ◽  
2018 ◽  
Vol 67 (10) ◽  
pp. 1757-1768 ◽  
Author(s):  
Joseph JY Sung ◽  
Philip WY Chiu ◽  
Francis K L Chan ◽  
James YW Lau ◽  
Khean-lee Goh ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Working Group ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Asia Pacific ◽  
Endoscopic Management ◽  
Three Stages ◽  
Upper Gastrointestinal

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

scholarly journals Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial

2021 ◽  
Vol 09 (10) ◽  
pp. E1504-E1511
Author(s):  
Vincent Quentin ◽  
André-Jean Remy ◽  
Gilles Macaigne ◽  
Rachida Leblanc-Boubchir ◽  
Jean-Pierre Arpurt ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Peptic Ulcers ◽  
Charlson Score ◽  
Factors Associated ◽  
Rockall Score ◽  
Upper Gastrointestinal

Abstract Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1–4) and Rockall score was 5 (IQR 3–6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04–2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31–2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39–2.80), being an inpatient (OR 2.45; 95 %CI 1.76–3.41) and rebleeding (OR 2.6; 95 %CI 1.85–3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.

scholarly journals EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING SECONDARY TO PEPTIC DISEASE IN A TERTIARY REFERRAL BRAZILIAN HOSPITAL

2021 ◽  
Author(s):  
Marcela FORGERINI ◽  
Gustavo URBANO ◽  
Tales Rubens de NADAI ◽  
Maruxa ZAPATA-CACHAFEIRO ◽  
Rafael KEMP ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Clinical Symptoms ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Tertiary Referral ◽  
Ulcer Disease ◽  
Number Of Patients ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.

P1953Risk of upper gastrointestinal bleeding following myocardial infarction: a novel prediction model for assessing appropriateness of proton pump inhibition therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T S G Sehested ◽  
P Blanche ◽  
P W Hansen ◽  
M G Charlot ◽  
C Torp-Pedersen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Gastrointestinal Bleeding ◽  
Prediction Model ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding following myocardial infarction continues to be a severe complication associated with increased mortality; however, bleeding events might be avoided by appropriate therapy with proton pump inhibitors. Purpose To develop and validate a prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding following myocardial infarction. Methods Based on multiple nationwide Danish registers, all patients initiating dual antiplatelet or anticoagulant therapy in combination with antiplatelet following myocardial infarction between 2003 and 2016 were identified. Primary outcome of interest was one-year risk of upper gastrointestinal bleeding. A derivation cohort including all patients between 2003 and 2013 was selected, whereas patients identified between 2014 and 2016 was employed for internal validation. Multiple logistic regression was used to predict person specific risks based on age, history of gastrointestinal bleeding or peptic ulcer, anaemia or gastrointestinal cancer, use of nonsteroidal anti-inflammatory drugs, oral anticoagulants, selective serotonin reuptake inhibitors or loop diuretics. We compared our model with the European Society of Cardiology (ESC) guideline recommendation on gastrointestinal bleeding risk assessment. Results A total of 61 543 patients with myocardial infarction were identified for the study. In the total cohort, the median age was 68 years (IQR: 58–77), 85.0% (52 334) underwent coronary angiography, 2.6% (1 608) had a history of gastrointestinal bleeding and 7.1% (4 354) used oral anticoagulants. The average one-year risk of upper gastrointestinal bleeding was 1.04% (95% CI: 0.95–1.14%), and mean predicted risk of the model was 1.04% (IQR: 0.64–1.26%). The discriminative ability of the model evaluated by area under the curve was 74.2% (95% CI: 66.9–78.6%) in the validation cohort. The proposed risk model demonstrated improved sensitivity and specificity at the specific threshold of the ESC risk schemes (Figure 1). Results remain principally unchanged regardless of inclusion or exclusion of patients initiating proton pump inhibitors at baseline. Furthermore, using cross-validation for the model evaluation produced similar discrimination results. Figure 1 Conclusion Based on nationwide registers a novel prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding was developed and validated; the model observed moderate discrimination in the validation cohort providing possible benefit for clinicians in terms of communicating absolute risk to the patients and determining the appropriateness of initiating preventive therapy. Acknowledgement/Funding The Danish Heart Foundation

scholarly journals Risk of upper gastrointestinal bleeding in patients on oral anticoagulant and proton pump inhibitor co-therapy

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253310
Author(s):  
Hyun-Jung Lee ◽  
Hyung-Kwan Kim ◽  
Bong-Sung Kim ◽  
Kyung-Do Han ◽  
Jun-Bean Park ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Gastrointestinal Bleeding ◽  
Proton Pump ◽  
Primary Endpoint ◽  
Oral Anticoagulant ◽  
Lower Risk ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Upper Gastrointestinal

Background Proton pump inhibitors (PPIs) are known to reduce the risk of upper gastrointestinal bleeding in patients on oral anticoagulants, and patients are increasingly on oral anticoagulants and PPI co-therapy. However, evidence is lacking on the safety and effectiveness of oral anticoagulants when co-administered with PPIs. Methods Among patients initiating oral anticoagulants (warfarin and non-vitamin K antagonist oral anticoagulants [NOACs], i.e. rivaroxaban, dabigatran, apixaban, and edoxaban) during 2013–2017, those concomitantly prescribed PPIs were identified (n = 19,851). The primary endpoint was hospitalization for major upper gastrointestinal bleeding, and secondary endpoints were death and ischemic stroke. Results During a mean 1.4 years of follow-up, the primary endpoint occurred in 512 (2.58%) patients. Overall, NOACs were associated with lower upper gastrointestinal bleeding risk after adjustment for age, sex, comorbidities and concomitant medications (adjusted hazard ratio 0.78, 95% confidence interval 0.65–0.94), compared to warfarin. There was no significant difference in upper gastrointestinal bleeding risk among the individual NOACs. This trend of reduced risk for upper gastrointestinal bleeding in NOACs compared to warfarin was consistent for both regular and reduced doses, throughout bleeding risk groups, and other subgroup analyses. NOACs were also associated with lower risk of death compared to warfarin. The risk for ischemic stroke was not significantly different among the oral anticoagulants in patients with atrial fibrillation. Conclusion In patients on oral anticoagulant and PPI co-therapy, NOACs were associated with lower risk of upper gastrointestinal bleeding and mortality compared to warfarin, while there was no difference among the oral anticoagulants for stroke prevention. In patients on PPI therapy, NOACs may preferred over warfarin for decreasing risk of upper gastrointestinal bleeding and mortality.

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