- Nieto JA, Camara T, Gonzalez-Higueras E, et al; RIETE Investigators. Findings from the RIETE Registry: clinical outcome of patients with major bleeding after venous thromboembolism. Thromb Haemost. 2008;100(5):789–796. doi:https://doi.org/10.1160/TH08-06-0390.
- Witt DM, Delate T, Garcia DA, et al. Risk of thromboembolism, recurrent hemorrhage, and death after warfarin therapy interruption for gastrointestinal tract bleeding. Arch Intern Med. 2012;172(19):1484–1491. doi:https://doi.org/10.1001/archinternmed.2012.4261.
- Sengupta N, Feuerstein JD, Patwardhan VR, et al. The risks of thromboembolism vs recurrent gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized inpatients with gastrointestinal bleeding: a prospective study. Am J Gastroenterol. 2015;110(2):328–335. doi:https://doi.org/10.1038/ajg.2014.398.
- Majeed A, Wallvik N, Eriksson J, et al. Optimal timing of vitamin K antagonist resumption after upper gastrointestinal bleeding: a risk modelling analysis. Thromb Haemost. 2017;117(3):491–499. doi:https://doi.org/10.1160/TH16-07-0498.
- Qureshi W, Mittal C, Patsias I, et al. Restarting anticoagulation and outcomes after major gastrointestinal bleeding in atrial fibrillation. Am J Cardiol. 2014;113(4):662–668. doi:https://doi.org/10.1016/j.amjcard.2013.10.044.
- Patel P, Nigam N, Sengupta N. Resumption of warfarin after hospitalization for lower gastrointestinal bleeding and mortality benefits. J Clin Gastroenterol. 2018;52(6):545–550. doi:https://doi.org/10.1097/MCG.0000000000000821.
- Thomopoulos KC, Mimidis KP, Theocharis GJ, Gatopoulou AG, Kartalis GN, Nikolopoulou VN. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome. World J Gastroenterol. 2005;11(9):1365–1368. doi:https://doi.org/10.3748/wjg.v11.i9.1365.
- Deutsch D, Romegoux P, Boustière C, Sabaté JM, Benamouzig R, Albaladejo P. Clinical and endoscopic features of severe acute gastrointestinal bleeding in elderly patients treated with direct oral anticoagulants: a multicentre study. Therap Adv Gastroenterol. 2019;12:1756284819851677. doi:https://doi.org/10.1177/1756284819851677.
- Halbritter K, Beyer-Westendorf J, Nowotny J, Pannach S, Kuhlisch E, Schellong SM. Hospitalization for vitamin-K-antagonist-related bleeding: treatment patterns and outcome. J Thromb Haemost. 2013;11(4):651–659. doi:https://doi.org/10.1111/jth.12148.
- Dahal K, Kunwar S, Rijal J, Schulman P, Lee J. Stroke, major bleeding, and mortality outcomes in warfarin users with atrial fibrillation and chronic kidney disease: a meta-analysis of observational studies. Chest. 2016;149(4):951–959. doi:https://doi.org/10.1378/chest.15-1719.
- Bhatia HS, Hsu JC, Kim RJ. Atrial fibrillation and chronic kidney disease: a review of options for therapeutic anticoagulation to reduce thromboembolism risk. Clin Cardiol. 2018;41(10):1395–1402. doi:https://doi.org/10.1002/clc.23085.
- Khalid F, Qureshi W, Qureshi S, Alirhayim Z, Garikapati K, Patsias I. Impact of restarting warfarin therapy in renal disease anticoagulated patients with gastrointestinal hemorrhage. Ren Fail. 2013;35(9):1228–1235. doi:https://doi.org/10.3109/0886022X.2013.819766.
- Sagripanti A, Barsotti G. Bleeding and thrombosis in chronic uremia. Nephron J. 1997;75(2):125–139. doi:https://doi.org/10.1159/000189522.
- Sagedal S, Hartmann A, Sundstrøm K, Bjørnsen S, Brosstad F. Anticoagulation intensity sufficient for haemodialysis does not prevent activation of coagulation and platelets. Nephrol Dial Transplant. 2001;16(5):987–993. doi:https://doi.org/10.1093/ndt/16.5.987.
- Staerk L, Lip GYH, Olesen JB, et al. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation: nationwide cohort study. BMJ. 2015;351:h5876. doi:https://doi.org/10.1136/bmj.h5876.
- Hippisley-Cox J, Coupland C. Predicting risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants: cohort study to derive and validate the QBleed scores. BMJ. 2014;349:g4606. doi:https://doi.org/10.1136/bmj.g4606.
- Coleman CI, Sobieraj DM, Winkler S, et al. Effect of pharmacological therapies for stroke prevention on major gastrointestinal bleeding in patients with atrial fibrillation. Int J Clin Pract. 2012;66(1):53–63. doi:https://doi.org/10.1111/j.1742-1241.2011.02809.x.
- Marmo R, Koch M, Cipolletta L, et al; Italian registry on upper gastrointestinal bleeding (Progetto Nazionale Emorragie Digestive—PNED 2). Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED score and prospective comparison with the Rockall score. Am J Gastroenterol. 2010;105(6):1284–1291. doi:https://doi.org/10.1038/ajg.2009.687.
- Aoki T, Nagata N, Niikura R, et al. Recurrence and mortality among patients hospitalized for acute lower gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2015;13(3):488–494.e1. doi:https://doi.org/10.1016/j.cgh.2014.06.023.
- Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–962. doi:https://doi.org/10.1016/S0140-6736(13)62343-0.
- Radaelli F, Dentali F, Repici A, et al. Management of anticoagulation in patients with acute gastrointestinal bleeding. Dig Liver Dis. 2015;47(8):621–627. doi:https://doi.org/10.1016/j.dld.2015.03.029.
- Abraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND. Gastrointestinal safety of direct oral anticoagulants: a large population-based study. Gastroenterology. 2017;152(5):1014–1022.e1. doi:https://doi.org/10.1053/j.gastro.2016.12.018.
- Chen WC, Chen YH, Hsu PI, et al. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. Biomed Res Int. 2014;2014:463767. doi:https://doi.org/10.1155/2014/463767.
- Sengupta N, Marshall AL, Jones BA, Ham S, Tapper EB. Rebleeding vs thromboembolism after hospitalization for gastrointestinal bleeding in patients on direct oral anticoagulants. Clin Gastroenterol Hepatol. 2018;16(12):1893–1900.e2. doi:https://doi.org/10.1016/j.cgh.2018.05.005.
- Pappas MA, Evans N, Rizk MK, Rothberg MB. Resuming anticoagulation following upper gastrointestinal bleeding among patients with nonvalvular atrial fibrillation—a microsimulation analysis. J Hosp Med. 2019;14(7):394–400. doi:https://doi.org/10.12788/jhm.3189.
- Shah SJ, Eckman MH. Restarting anticoagulants after a gastrointestinal hemorrhage—between Rockall and a hard place. J Hosp Med. 2019;14(7):448–449. doi:https://doi.org/10.12788/jhm.3221.
- Tapaskar N, Pang A, Werner DA, Sengupta N. Resuming anticoagulation following hospitalization for gastrointestinal bleeding is associated with reduced thromboembolic events and improved mortality: results from a systematic review and meta-analysis. Dig Dis Sci. 2021;66(2):554–566. doi:https://doi.org/10.1007/s10620-020-06248-9.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline—update 2021. Endoscopy. 2021;53(3):300–332. doi:https://doi.org/10.1055/a-1369-5274.
- Veitch AM, Radaelli F, Alikhan R, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021;70(9):1611–1628. doi:https://doi.org/10.1136/gutjnl-2021-325184.
- Chai-Adisaksopha C, Hillis C, Monreal M, Witt DM, Crowther M. Thromboembolic events, recurrent bleeding and mortality after resuming anticoagulant following gastrointestinal bleeding: a meta-analysis. Thromb Haemost. 2015;114(10):819–825. doi:https://doi.org/10.1160/TH15-01-0063.
Management dilemmas in restarting anticoagulation after gastrointestinal bleeding
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