Management of anticoagulation in patients with acute gastrointestinal bleeding.
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.
Department of Gastroenterology, Valduce Hospital, Como, Italy. Electronic address: francoradaelli@virgilio.it.
Franco
F
Radaelli
Department of Clinical Medicine, University of Insubria, Varese, Italy.
Francesco
F
Dentali
Gastrointestinal Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy.
Alessandro
A
Repici
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Arnaldo
A
Amato
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Silvia
S
Paggi
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Emanuele
E
Rondonotti
Gedyt Endoscopy Centre, Buenos Aires, Argentina.
Jean Marc
JM
Dumonceau
D000074:Acenocoumarol / Q000009:adverse effects; D000208:Acute Disease; D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects*; D003029:Coagulants / Q000627:therapeutic use*; D000069604:Dabigatran / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D000069552:Rivaroxaban / Q000009:adverse effects; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D003029:Coagulants; D014812:Vitamin K; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; D000074:Acenocoumarol
Anticoagulation reversal; Gastrointestinal bleeding; Oral anticoagulants