Management of Oral Anticoagulation Therapy After Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy

2017 ◽  
Vol 51 (11) ◽  
pp. 1000-1007 ◽  
Author(s):  
Kazuhiko Kido ◽  
Michael J. Scalese
Keyword(s):  
Gastrointestinal Bleeding ◽  
Cohort Studies ◽  
Oral Anticoagulation ◽  
Retrospective Cohort ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Cochrane Library ◽  
Oral Anticoagulation Therapy ◽  
Retrospective Cohort Studies

Objective: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. Data Sources: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban.Study Selection and Data Extraction: All English-language studies assessing management of oral anticoagulation therapy after GIB were evaluated. Data Synthesis: A total of 9 studies were identified. Four retrospective cohort studies showed that resuming anticoagulation therapy was associated with significantly lower rate of thromboembolism (TE) in the general population. Meta-analyses and prospective cohort studies also supported this finding. Two retrospective cohort studies indicated an increase in GIB when anticoagulation reinitiation occurred in less than 7 days without a decrease in TE. Resuming therapy between 7 and 15 days did not demonstrate a significant increase in GIB or TE. A large retrospective study showed that apixaban was associated with the significantly lowest risk of GIB compared with both rivaroxaban and dabigatran. Conclusion: Anticoagulation therapy resumption is recommended, with resumption being considered between 7 and 14 days following GIB regardless of the therapy chosen. Data for warfarin management after GIB should be applied with caution to direct oral anticoagulants (DOACs) because of the quicker onset and experimental nature of reversal agents. Apixaban may be a preferred option when restarting a DOAC therapy.

scholarly journals Effects and safety of intraoperative intermittent pneumatic compression for preventing postoperative venous thromboembolism: a meta-analysis

2021 ◽  
Author(s):  
Yanping Yang ◽  
Jianhua Li
Keyword(s):  
Cohort Studies ◽  
Retrospective Cohort ◽  
Meta Analysis ◽  
Intermittent Pneumatic Compression ◽  
Surgical Patients ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Knowledge Infrastructure ◽  
Retrospective Cohort Studies ◽  
Newcastle Ottawa Scale

IntroductionIntermittent pneumatic compression (IPC) has been used for venous thrombosis (VTE) prevention. It’s necessary to evaluate the effects and safety of intraoperative use of IPC devices in the prevention of VTE in surgical patients.Material and methodsTwo authors independently searched the PubMed, Cochrane Library, MedLine, EMbase, China national knowledge infrastructure (CNKI), Wanfang databases for randomized controlled trials (RCTs) and cohort studies on the use of IPC in surgical patients up to June 10, 2021. The Cochrane Collaborations risk of bias tool and Newcastle-Ottawa Scale (NOS) were used for quality assessment. RevMan 5.3 software were used for statistical analyses.ResultsA total of 13 studies including seven RCTs and six retrospective cohort studies involving 6673 surgical patients were included, 1883 patients underwent IPC intervention. The synthesized RCT results indicated that IPC was beneficial to the reduce the incidence of DVT (RR0.30, 95%CI0.22~0.40, P<0.001) and VTE (RR0.51, 95%CI0.27~0.95, P=0.03). The synthesized results from retrospective cohort studies indicated that IPC is beneficial to the reduce the incidence of DVT (RR0.63, 95%CI0.42~0.96, P=0.03) and PE (RR0.34, 95%CI0.16~0.72, P=0.005). No significant publication biases were found for all synthesized outcomes (all p>0.05).ConclusionsIPC seems to be safe and effective in the prevention and management of intraoperative VTE. Limited by sample size, this conclusion still needs to be further confirmed by large-sample, multi-center, high-quality clinical studies.

The Association between Metformin and Survival of Head and Neck Cancer: A Systematic Review and Meta-Analysis of 7 Retrospective Cohort Studies

2020 ◽  
Vol 26 (26) ◽  
pp. 3161-3170 ◽  
Author(s):  
Yongbo Wang ◽  
Tao Fu ◽  
Yu Liu ◽  
Guifang Yang ◽  
Chuanhua Yu ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Cohort Studies ◽  
Head And Neck ◽  
Neck Cancer ◽  
Retrospective Cohort ◽  
Cancer Survival ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Cochrane Library ◽  
Retrospective Cohort Studies

Background: Metformin has been associated with improved survival outcomes in various malignancies. However, observational studies in head and neck cancer are inconsistent. Objective: The study aimed to summarize and quantify the relationship between metformin use and the survival of head and neck cancer. Methods: A meta-analysis based on cohort studies was systematically conducted (published up to Jan 18, 2020), identified from PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus databases. Summary hazard ratios (HR) and 95% confidence intervals (CI) were calculated using a random-effects model. Results: Seven retrospective cohort studies including 3,285 head and neck cancer patients were included. The association between the use of metformin and cancer survival was not statistically significant: summarized HR of 0.89 (95% CI 0.66-1.18, P=0.413, I2=64.0%) for overall survival, summarized HR of 0.65 (95% CI 0.31-1.35, P=0.246, I2=60.3%) for disease-free survival, and summarized HR of 0.69 (95% CI 0.40-1.20, P=0.191, I2=73.1%) for disease-specific survival. Conclusion: In this meta-analysis of 7 retrospective cohort studies, there was not a statistically significant association between the use of metformin and better survival for head and neck cancer. However, the analysis may have been underpowered. More studies of prospective designs with larger sample sizes are needed to investigate the effect of metformin on the survival of head and neck cancer.

scholarly journals The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

2018 ◽  
Vol 91 (1) ◽  
pp. 37-41
Author(s):  
Adelina-Mihaela Sorescu ◽  
Tudor Enache ◽  
Suzana Guberna
Keyword(s):  
Oral Anticoagulation ◽  
Economic Status ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Cross Sectional Study ◽  
Similar Data ◽  
Cross Sectional ◽  
Oral Anticoagulation Therapy ◽  
Vein Thrombosis

Background and aims. Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT.Methods. We designed a cross-sectional study of the patients admitted to the Cardiology Department of the “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017. We considered OAT indications to be: atrial fibrillation/flutter (AF), pulmonary embolisms (PE), deep vein thrombosis (DVT), intramural or intracavitary thrombi and left ventricle aneurysms. Statistical analysis was performed with EpiInfo.Results. There were 783 patients admitted, 253 of these having an OAT indication (mean age 73.25 years, 53.75% female). Only 162 patients (64.03%) received it, either Vitamin K Antagonists (VKA) (78 patients, 48.14%), or Novel Oral Anticoagulants (NOAC) (84 patients, 51.85%). Reasons for not indicating such therapy included the hemorrhage risk (43.27%), the lack of adherence to the treatment (18.56%), the impossibility of INR monitoring (21.84%), the economic status (10.21%) and others (6.12%). 221 patients had AF (87.35%), 141 (63.8%) receiving OAT, VKA (67 patients, 47.51%), or NOAC (74 patients, 52.48%). 17 patients (6.71%) had a PE and/or DVT. 15 (88.23%) received OAT, AVK (11 patients, 73.33%), or NOAC (4 patients, 26.67%). 15 patients (5.92%) had other OAT indications (excepting AF or PE/DVT), 11 receiving OAT (73.33%), AVK (8 patients, 72.72%), or NOAC (3 patients, 27.27%).Conclusions. Our study determined that 64.03% of those with indication received OAT. Similar data is reported in the USA, suggesting an underuse of anticoagulants. The risk of hemorrhage, lack of adherence, the impossibility of INR monitoring or the economic status were some of the reasons for not recommending OAT.

Management of epistaxis in patients on novel oral anticoagulation therapy

2020 ◽  
Vol 134 (4) ◽  
pp. 316-322
Author(s):  
J P K Ho ◽  
N Bari ◽  
F Riffat
Keyword(s):  
Oral Anticoagulation ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Efficacy And Safety ◽  
Oral Anticoagulation Therapy ◽  
Reversal Agents ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Comprehensive Search ◽  
Anticoagulated Patients

AbstractBackgroundIndividuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy.ObjectiveThis paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management.MethodA comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019.ResultsPatients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined.ConclusionClinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.

scholarly journals Gastrointestinal Bleeding and Direct Oral Anticoagulants among Patients with Atrial Fibrillation: Risk, Prevention, Management, and Quality of Life

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e200-e210
Author(s):  
Paolo Zappulla ◽  
Valeria Calvi
Keyword(s):  
Quality Of Life ◽  
Gastrointestinal Bleeding ◽  
Current Knowledge ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Current Evidence ◽  
Increased Risk

AbstractA significant problem for patients undergoing oral anticoagulation therapy is gastrointestinal bleeding (GIB), a problem that has become increasingly urgent following the introduction of direct oral anticoagulants (DOACs). Furthermore, in recent years a greater focus has been placed on the quality of life (QOL) of patients on long-term oral anticoagulant therapy, which necessitates changes in lifestyle, as well as posing an increased risk of bleeding without producing objective symptomatic relief. Here, we examine current evidence linked to GIB associated with oral anticoagulants, with a focus on randomized control trials, meta-analyses, and postmarketing observational studies. Rivaroxaban and dabigatran (especially the 150-mg bis-in-die dose) appeared to be linked to an increased risk of GIB. The risk of GIB was also greater when edoxaban was used, although this was dependent on the dose. Apixaban did not pose a higher risk of GIB in comparison with warfarin. We provided a summary of current knowledge regarding GIB risk factors for individual anticoagulants, prevention strategies that lower the risk of GIB and management of DOAC therapy after a GIB episode.

Direct oral anticoagulation and mortality in moderate to high-risk atrial fibrillation

Heart ◽  
2019 ◽  
Vol 105 (19) ◽  
pp. 1487-1492 ◽  
Author(s):  
Ronen Arbel ◽  
Ruslan Sergienko ◽  
Ariel Hammerman ◽  
Sari Dotan-Greenberg ◽  
Erez Batat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Treated Group ◽  
Newly Diagnosed ◽  
Risk Of Death ◽  
All Cause Mortality

ObjectiveAlthough direct oral anticoagulants (DOAC) are the recommended antithrombotic therapy for patients with non-valvular atrial fibrillation (NVAF), anticoagulation in patients with NVAF is still inadequate. The effect of withholding DOAC therapy on patient survival is unknown. Therefore, our objective was to compare all-cause mortality rates between DOAC-treated patients with NVAF and similar patients receiving no anticoagulation.MethodsWe performed a retrospective cohort study analysing Clalit Health Services’ extensive electronic database, regarding all newly diagnosed, anticoagulant-naïve patients with NVAF who were eligible for DOAC therapy from 1 January 2011 to 31 December 2016. Patients who received DOAC therapy were matched by propensity scoring to patients receiving no anticoagulation. The primary outcome was all-cause mortality. Final patient follow-up date was 15 May 2017.Results18 901 eligible patients were identified. 8298 received treatment with a DOAC and 10 603 received no anticoagulation therapy. Of those, 5657 patients who received DOAC therapy were matched with 5657 patients who did not receive any anticoagulant. Death occurred in 715 patients in the DOAC-treated group (7.6% per year) and in 2075 patients in the non-anticoagulated patient group (11.1% per year). DOAC therapy was associated with significantly lower risk for all-cause mortality (HR=0.69, 95% CI 0.63 to 0.75, p<0.001). The benefit of DOAC therapy was demonstrated across all subgroups analysed.ConclusionsIn this cohort of newly diagnosed patients with NVAF, DOAC therapy was associated with a significantly lower risk of death compared with no oral anticoagulation. Our findings provide further evidence for the importance of providing DOAC anticoagulation in patients with NVAF.

scholarly journals Impact of oral anticoagulation therapy on postoperative atrial fibrillation outcomes: a systematic review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mariana Fragão-Marques ◽  
Francisco Teixeira ◽  
Jennifer Mancio ◽  
Nair Seixas ◽  
João Rocha-Neves ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Random Effect ◽  
Anticoagulation Therapy ◽  
Thromboembolic Events ◽  
Oral Anticoagulation Therapy ◽  
All Cause Mortality

Abstract Background Post-operative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Recent studies had shown this phenomenon is no longer considered transitory and is associated with higher risk of thromboembolic events or death. The aim of this study was to systematically review and analyze previous studies comparing oral anticoagulation therapy with no anticoagulation, regarding these long-term outcomes. Methods PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Database were systematically searched to identify the studies comparing the risk of stroke, or thromboembolic events or mortality of POAF patients who received anticoagulation compared with those who were not anticoagulated. Incidence of stroke, thromboembolic events and all-cause mortality were evaluated up to 10 years after surgery. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance and the early endpoints using frequencies or odds ratio (OR). Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). Heterogeneity was evaluated through Q statistic-related measures of variance (Tau2, I2, Chi-squared test). Results Eight observational cohort studies were selected, including 15,335 patients (3492 on Oral Anticoagulants (OAC) vs 11,429 without OAC) that met the inclusion criteria for qualitative synthesis. Patients had a wide gender distribution (38.6–82.3%), each study with a mean age above 65 years (67.5–85). Vitamin K antagonists were commonly prescribed anticoagulants (74.3–100%). OAC was associated with a protective impact on all-cause mortality at a mean of 5.0 years of follow-up (HR is 0.85 [0.72–1.01]; p = 0.07; I2 = 48%). Thromboembolic events did not differ between the two treatment arms (HR 0.68 [0.40–1.15], p = 0.15). Conclusion Current literature suggests a possibly protective impact of OAC therapy for all-cause mortality in patients with new-onset atrial fibrillation after cardiac surgery. However, it does not appear to impact thromboembolism rate.

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