The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Anticoagulation Strategies in Patients With Cancer: JACC Review Topic of the Week

Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of ∼67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range ∼1-5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.

Non-variceal upper gastrointestinal bleeding.

Introduction: Gastrointestinal bleeding (GIB) is a major problem in patients on oral anticoagulation therapy. This issue has become even more pressing since the introduction of direct oral anticoagulants (DOACs) in 2009.Areas covered: Here we review current evidence related to GIB associated with oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and post-marketing observational studies. Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily increase the risk of GIB compared to warfarin. The risk increase with edoxaban is dose-dependent, while apixaban shows apparently, no increased risk. We summarize what is known about GIB risk factors for individual anticoagulants, the location of GIB in patients taking these compounds, and prevention strategies that lower the risk of GIB.Expert opinion: Recently there has been an important shift in the clinical presentation of GIB. Specifically, upper GIB has decreased with the decreased incidence of peptic ulcers due to the ...

Risk of gastrointestinal bleeding during anticoagulant treatment.

Background Several studies have investigated the effect of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer, but the results remain controversia...

Non–Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Major Gastrointestinal Bleeding Often Is Caused by Occult Malignancy in Patients Receiving Warfarin or Dabigatran to Prevent Stroke and Systemic Embolism From Atrial Fibrillation

Incidence and Clinical Presentation of Gastrointestinal Bleeding in Atrial Fibrillation Patients Taking Direct Oral Anticoagulants

Assessment and Management of Gastrointestinal Hemorrhage in the Setting of Direct Oral Anticoagulants: The Hematology Perspective

792 Do Concurrent Gastroprotective Agents Impact Gastrointestinal Bleeding Rates in Edoxaban Users? Results From the ENGAGE-AF TIMI 48 Trial

Tu1357 Idarucizumab for Emergent Reversal of Dabigatran-Related Anticoagulation During Severe Gastrointestinal Hemorrhage: Interim Results (N=123) From the Reverse-Ad™ Study

Prapti Chatterjee

Papers

Major Gastrointestinal Bleeding Often Is Caused by Occult Malignancy in Patients Receiving Warfarin or Dabigatran to Prevent Stroke and Systemic Embolism From Atrial Fibrillation

Incidence and Clinical Presentation of Gastrointestinal Bleeding in Atrial Fibrillation Patients Taking Direct Oral Anticoagulants

Assessment and Management of Gastrointestinal Hemorrhage in the Setting of Direct Oral Anticoagulants: The Hematology Perspective

792 Do Concurrent Gastroprotective Agents Impact Gastrointestinal Bleeding Rates in Edoxaban Users? Results From the ENGAGE-AF TIMI 48 Trial

Tu1357 Idarucizumab for Emergent Reversal of Dabigatran-Related Anticoagulation During Severe Gastrointestinal Hemorrhage: Interim Results (N=123) From the Reverse-Ad™ Study