warfarin and Angiodysplasia

Different oral anticoagulants may be associated with gastrointestinal bleeding (GIB) from different locations or mucosal lesions. We aimed to test this hypothesis.. Two blinded gastroenterologists independently analyzed source documents from the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial of dabigatran 150 mg BID (D150), dabigatran 110 mg BID (D110) versus warfarin in non-valvular atrial fibrillation (NVAF).. Major GIB events (total n = 546) and life-threatening GIB events (n = 258) were more common with D150 versus warfarin (RR 1.57 [1.28-1.92] and RR 1.62 [1.20-2.18], respectively) and similar for D110 compared to warfarin (RR 1.11 [0.89-1.38] and RR 1.16 [0.84-1.61], respectively). Fatal bleeding was similarly rare across treatment groups. Lower GI major bleeding and life-threatening bleeding were more common with D150 compared to warfarin (RR 2.23 [1.47, 3.38] and RR 2.64 [1.36, 5.13], respectively) and with D110 compared to warfarin (RR 1.78 [1.16, 2.75] and RR 2.00 [1.00, 4.00], respectively). MGIB from colonic angiodysplasia was increased with dabigatran versus warfarin (P < 0.01 for both dose comparisons). Subacute and chronic MGIB events were more common with D150 than with warfarin (RR 1.72 [1.06, 2.78] and RR 1.66 [1.12, 2.45], respectively), as were hematochezia or melena (RR 1.67 [1.18, 2.36] and RR 1.72 [1.20, 2.47], respectively).. In a chronic NVAF population, D150 but not D110 is associated with increased major and life-threatening GI bleeding in comparison with warfarin. At both dabigatran doses, increased bleeding from the colorectum, in particular from angiodysplasia, is seen.

Topics: Administration, Oral; Angiodysplasia; Anticoagulants; Antithrombins; Atrial Fibrillation; Colon; Dabigatran; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Odds Ratio; Randomized Controlled Trials as Topic; Rectum; Retrospective Studies; Risk Factors; Treatment Outcome; Warfarin

Topics: Aged; Angiodysplasia; Blood Coagulation Tests; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Heart Failure; Heart-Assist Devices; Humans; Male; Prosthesis Design; Pyrazoles; Pyridones; Risk Factors; Thrombosis; Treatment Outcome; Ventricular Function, Left; Warfarin

Topics: Angiodysplasia; Gastrointestinal Hemorrhage; Heart Failure; Heart-Assist Devices; Humans; Male; Pyrazoles; Pyridones; Ventricular Function, Left; Warfarin

Topics: Aged; Angiodysplasia; Anticoagulants; Blood Urea Nitrogen; Capsule Endoscopy; Cecal Diseases; Cecum; Diagnosis, Differential; Dizziness; Esophagitis; Gastrointestinal Hemorrhage; Heart-Assist Devices; Humans; Male; Myocardial Ischemia; Warfarin

We reported 3 cases of the uncommon type of persistent gastrointestinal bleeding during anticoagulation therapy due to cardiovascular disorders or collagen disease. Endoscopic observation showed non pulsatile active bleeding from apparently normal mucosa, without any ulcer or obvious vascularectasia. The outflow of bleeding was string-like and continuous. Based on previous reports, we considered the possibly of these cases unique bleeding angiodysplasia and angiodysplasia during anticoagulation therapy. The frequency of this type of bleeding may increase, as anticoagulation therapy has become more common. We should pay attention to such lesions when we treat gastrointestinal bleeding.

Topics: Aged; Angiodysplasia; Anticoagulants; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Middle Aged; Warfarin

Topics: Aged, 80 and over; Angiodysplasia; Anticoagulants; Aortic Valve Stenosis; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis Implantation; Humans; Syndrome; Warfarin

Bleeding is the most common complication of anticoagulant therapy. Despite the frequency of its occurrence, little evidence is available to guide the care of anticoagulated patients with, or at high risk of, bleeding. This article attempts, using a case based format, to describe common clinical scenarios encountered by clinicians who manage anticoagulated patients and who are bleeding. The paper is "case based" and narrative since there is little evidence to guide practice in this area.

Topics: Aged; Aged, 80 and over; Angiodysplasia; Anticoagulants; Atrial Fibrillation; Case-Control Studies; Duodenal Ulcer; Female; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Mitral Valve; Warfarin; Young Adult

We present a patient receiving chronic anticoagulant treatment with recurrent and intractable gastrointestinal bleeding due to diffuse angiodysplasia. Following failure of previous medical and surgical treatment, and in light of the patient's need for chronic anticoagulation due to mechanical heart valve, she was treated with somatostatin analogue, octreotide s.c. 100 microg on alternate days for 28 months. Treatment significantly decreased the occurrence of bleeding episodes, the need for hospitalization and blood transfusion requirements despite continued anticoagulant therapy. Octreotide treatment should be considered in patients with refractory gastrointestinal bleeding due to angiodysplasia in particular in those who need anticoagulant treatment.

Topics: Aged; Angiodysplasia; Anticoagulants; Chronic Disease; Drug Administration Schedule; Female; Gastrointestinal Hemorrhage; Hemostatics; Humans; Octreotide; Warfarin

Colonic angiodysplasia is one of the most frequent causes of recurrent lower gastrointestinal tract bleeding, mainly in the elderly. In 50% of patients multiple angiodysplastic lesions were reported when they were the cause of rectal bleeding. Bleeding from angiodysplasia is more severe and less responsive to treatment in those with coagulation disorders. A 74-year-old woman with an artificial mitral valve who was treated with coumadine is reported. A few years after operation she began to develop severe recurrent rectal bleeding because of multiple angiodysplastic lesions along the right colon, proven by colonoscopy. She was frequently hospitalized for blood transfusions; endoscopic treatment was not feasible and the surgical risk of colectomy was very high. Treatment with estrogen and progesterone significantly decreased recurrent episodes of bleeding.

Topics: Aged; Angiodysplasia; Anticoagulants; Blood Transfusion; Colonic Diseases; Ethinyl Estradiol; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Norgestrel; Warfarin

Topics: Aged; Angiodysplasia; Aortic Valve Stenosis; Calcinosis; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Male; Recurrence; Syndrome; Warfarin