[Gastrointestinal bleeding in cardiological patients]
1III. Medizinische Klinik, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland, georg.braun@klinikum-augsburg.de.
Insights
Gastrointestinal bleeding from anticoagulants like rivaroxaban and dabigatran requires specific management. This study outlines a standard operating procedure for treating severe GI bleeding during these therapies.
Area of Science:
- Internal Medicine
- Pharmacology
- Gastroenterology
Context:
- Oral anticoagulation and antiplatelet therapies increase the risk of gastrointestinal (GI) bleeding.
- Lower GI bleeding is associated with poorer patient outcomes.
- Newer anticoagulants like dabigatran and rivaroxaban present management challenges for bleeding complications.
Purpose:
- To establish a standard operating procedure (SOP) for managing severe GI bleeding associated with rivaroxaban, dabigatran, and antiplatelet therapy.
- To provide guidance on treating bleeding complications during anticoagulant and antiplatelet therapy.
Summary:
- Phenprocoumon-related bleeding should be managed with prothrombin complex concentrates and vitamin K1.
- Drug concentrations of dabigatran and rivaroxaban can indicate bleeding risk.
- Severe bleeding from dabigatran or rivaroxaban warrants prothrombin complex therapy; antiplatelet-related bleeding requires platelet transfusion.
- Low-dose aspirin should be resumed after 24 hours post-bleeding event.
Impact:
- Provides a clear management protocol for severe GI bleeding in patients on novel oral anticoagulants and antiplatelet agents.
- Aims to improve patient outcomes by standardizing treatment for life-threatening GI bleeds.
- Facilitates consistent and effective care for complex bleeding scenarios in clinical practice.
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.
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