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2015 ; 94
(1
): e377
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Gastrointestinal bleeding and anticoagulant or antiplatelet drugs: systematic
search for clinical practice guidelines
#MMPMID25569664
Gutermann IK
; Niggemeier V
; Zimmerli LU
; Holzer BM
; Battegay E
; Scharl M
Medicine (Baltimore)
2015[Jan]; 94
(1
): e377
PMID25569664
show ga
Gastrointestinal (GI) bleeding is a frequently encountered and very serious
problem in emergency room patients who are currently being treated with
anticoagulant or antiplatelet medications. There is, however, a lack of clinical
practice guidelines about how to respond to these situations. The goal of this
study was to find published articles that contain specific information about how
to safely adjust anticoagulant and antiplatelet therapy when GI bleeding
occurs.The investigators initiated a global search on the PubMed and Google
websites for published information about GI bleeding in the presence of
anticoagulant or antiplatelet therapy. After eliminating duplicate entries, the
medical articles that remained were screened to narrow the sets of articles to
those that met specific criteria. Articles that most closely matched study
criteria were analyzed in detail and compared to determine how many actual
guidelines exist and are useful.We could provide only minimal information about
appropriate therapeutic strategies because no articles provided sufficient
specific advice about how to respond to situations involving acute GI bleeding
and concurrent use of anticoagulant or antiplatelet drugs. Only 4 articles
provided enough detail to be of any use in an emergency situation.Clinical
practice guidelines and also clinical trials for GI hemorrhaging should be
expanded to state in which situations the use of anticoagulant or antiplatelet
drugs should be suspended and the medications should later be resumed, and they
should state the level of risk for any particular action.