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PPIs and Beyond: A Framework for Managing Anticoagulation-Related Gastrointestinal Bleeding in the Era of COVID-19

Parita Patel1, Neil Sengupta2

  • 1Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, 5841 S Maryland Avenue,MC 4076, Chicago, IL, 60637, USA.

Digestive Diseases and Sciences
|June 16, 2020
PubMed

Insights

This review addresses gastrointestinal bleeding (GIB) in COVID-19 patients receiving anticoagulation. It emphasizes risk stratification and preventive strategies to reduce GIB complications and hospital readmissions.

Area of Science:

  • Internal Medicine
  • Gastroenterology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to severe coagulopathy and thromboembolic events.
  • Anticoagulation is increasingly used in COVID-19 patients to prevent thrombotic complications.
  • This practice raises concerns about managing associated gastrointestinal bleeding (GIB).

Purpose of the Study:

  • To review strategies for identifying high-risk COVID-19 patients for GIB.
  • To discuss methods for mitigating GIB risk in patients on anticoagulation.
  • To improve patient outcomes and reduce hospital readmissions for GIB.

Main Methods:

  • Literature review on GIB in COVID-19 patients.
  • Analysis of risk factors for GIB in anticoagulated patients.
  • Discussion of preventive measures including PPI co-therapy, medication reconciliation, and H. pylori management.

Main Results:

  • Severe COVID-19 can lead to coagulopathy and thrombosis, necessitating anticoagulation.
  • Anticoagulation increases the risk of gastrointestinal bleeding (GIB).
  • Proactive risk assessment and management are crucial for preventing GIB.

Conclusions:

  • Appropriate risk stratification is essential before initiating anticoagulation in COVID-19 patients.
  • Proton-pump inhibitor co-therapy, medication review, and H. pylori treatment can mitigate GIB risk.
  • Effective GIB management is vital for improving outcomes in hospitalized COVID-19 patients.

Keywords:
AnticoagulationCOVID-19Gastrointestinal bleedingThrombosis

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