title: [Gastrointestinal bleeding in cardiological patients].
abstract: Oral anticoagulation and antiplatelet therapy are risk factors for gastrointestinal (GI) bleeding. GI bleeding-especially lower GI bleeding-seems to be associated with a poorer outcome. With the introduction of dabigatrane and rivaroxaban, difficulties in the management of bleeding complications arose. Thus, the goal of the authors was to establish a standard operating procedure (SOP) for the treatment of severe GI bleeding associated with rivaroxaban, dabigatrane, and antiplatelet therapy. Bleeding complications during phenprocoumon treatment should be treated with prothrombin complex concentrates and vitamin K1. Dabigatrane elimination is highly dependent to the renal function. The measurement of drug concentrations of dabigatrane and rivaroxaban is useful to indicate an increased risk of bleeding complications. Severe bleeding associated with dabigatrane or rivaroxaban therapy should trigger prothrombin complex therapy, whereby in cases with severe bleeding associated with antiplatelet therapy platelet transfusion should be initiated. Low-dose aspirin should be continued after 24 h.
authors.affiliation: III. Medizinische Klinik, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland, georg.braun@klinikum-augsburg.de.
authors.forename: G
authors.initials: G
authors.lastname: Braun
authors.forename: H
authors.initials: H
authors.lastname: Messmann
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D000069604:Dabigatran; D016903:Drug Monitoring; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D008657:Metabolic Clearance Rate / Q000502:physiology; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D010644:Phenprocoumon / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D017713:Platelet Transfusion; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D001779:Blood Coagulation Factors; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D015091:beta-Alanine; D014812:Vitamin K; C025667:prothrombin complex concentrates; D000069552:Rivaroxaban; D000069604:Dabigatran; D010644:Phenprocoumon