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64. Diagnosis and management of acute lower gastrointestinal bleeding

to its short half- life, but in severe life-threatening haemorrhage its effects can be reversed with protamine sulfate. The anticoagulant effect of low molecular weight heparin may persist for 24 hours and prota- mine sulfate is less effective. 11. We suggest that aspirin for primary prophylaxis of cardio- vascular events should be permanently discontinued (weak recommendation, low quality evidence). 12. We recommend that aspirin for secondary prevention is not routinely stopped. If it is stopped (...) , although there was no associated increase in interventions to treat bleeding or mortality. 112 Aspirin irreversibly inhibits the function of platelets for their lifespan (5–7 days). Its effect on endothelial prostaglandin synthesis is, however, much shorter, and there may be benefits in temporarily stopping aspirin if severe haemorrhage occurs. In patients receiving single antiplatelet agents most rebleeding occurs within 5 days of the index event. 112 The risk: benefit anal- ysis of discontinuing

2019 British Society of Gastroenterology

66. Management of Stroke in Neonates and Children Full Text available with Trip Pro

and anemia. Antiplatelet therapy such as aspirin and anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) is rarely indicated because of the low risk of recurrent stroke after neonatal AIS; however, it must be considered in those exceptional neonates with high risk of recurrent AIS resulting from documented thrombophilia or complex congenital heart disease (not including patent foramen ovale [PFO]). , Hyperacute stroke therapies (thrombolytics and mechanical (...) the eventual outcome. Ventricular drainage and, if indicated, later shunting for progressive hydrocephalus resulting from IVH is appropriate. Considerations for Clinical Practice Vitamin K should be routinely administered to newborns. Larger doses of vitamin K may be needed to correct factor deficiencies resulting from maternal medications. Aspirin, LMWH, or UFH may be considered in neonates at risk for stroke recurrence because of severe thrombophilia or cerebral embolism resulting from cardiac disease

2019 American Heart Association

67. Risk factors for breast cancer: A review of the evidence 2018

4.7.12 Diet—foods high in carotenoids 108 4.7.13 Diet—Mediterranean diet 110 4.7.14 Diet—phytoestrogens 112 Breast cancer risk factors: A review of the evidence iv 4.7.15 Diet—glycaemic index 114 4.7.16 Diet—total energy 115 4.7.17 Diet—sugar 117 4.7.18 Diet—fat 118 4.7.19 Diet—processed meat 119 4.7.20 Diet—red meat 121 4.7.21 Environmental tobacco smoke 123 4.7.22 Tobacco smoking 125 4.7.23 Physical activity 127 4.7.24 Shift work disrupting circadian rhythm 130 4.8 Medical factors 133 4.8.1 Aspirin (...) and risk of breast cancer 393 Table D.53 Diet—processed meat and risk of breast cancer 395 Table D.54 Diet—red meat and risk of breast cancer 398 Table D.55 Environmental tobacco smoke and risk of breast cancer 401 Table D.56 Tobacco smoking and risk of breast cancer 405 Table D.57 Physical activity and risk of breast cancer 409 Table D.58 Shift work disrupting circadian rhythm and risk of breast cancer 415 Table D.59 Aspirin and risk of breast cancer 420 Table D.60 Cardiac glycosides and risk

2018 Cancer Australia

68. Access to Hormonal Contraception

of harm. For example, common nonsteroidal antiinflam- matory drugs, such as aspirin and ibuprofen, have documented adverse effects, including gastrointestinal bleeding (29). These effects may occur even at low doses used for prophylaxis of cardiovascular disease. e98 Committee Opinion Access to Hormonal Contraception OBSTETRICS & GYNECOLOGYAdditionally, over-the-counter use of acetaminophen is linked to serious liver damage (30). Safety concerns about hormonal contraception fre- quently focus

2019 American College of Obstetricians and Gynecologists

69. Recommendations for Prevention and Control of Influenza in Children, 2019–2020

because of the potential for increased wheezing after immunization. In this age range, many children have a history of wheezing with respiratory tract illnesses and are eventually diagnosed with asthma; children who have known or suspected immunodeficiency disease or who are receiving immunosuppressive or immunomodulatory therapies; close contacts and caregivers of those who are severely immunocompromised and require a protected environment; children and adolescents receiving aspirin or salicylate

2019 American Academy of Pediatrics

70. Point of Care in General Haematology Full Text available with Trip Pro

of dabigatran and apixaban (Ebner et al , ). The Hemochron® Signature has demonstrated a good correlation with rivaroxaban and dabigatran measurement by liquid chromatography‐tandem mass spectrometry (Ebner et al , ). Similarly, TEG and ACT have been shown to be useful in the detection and reversal of dabigatran‐induced coagulopathy, and the former in the detection of DOACs with high specificity and sensitivity (Bianchi et al , ; Dias et al , ). The increasing use of aspirin and oral P2Y inhibitors (...) in the prevention and management of arterial thrombosis, and whether or not a patient is aspirin "resistant" or clopidogrel "resistant", has promoted extensive research into development of POC devices for measurement of platelet inhibition by said anti‐platelet medications (Dionizovik‐Dimanovski et al , ). However, many studies have failed to show a true benefit, therefore the clinical utility of POC systems in this area is yet to confirmed (Ebner et al , ; Michelson & Bhatt, ). Blood gas and Hb/haematocrit

2019 British Committee for Standards in Haematology

72. Guidelines for the management of hereditary colorectal cancer

colonoscopy should be performed from age 40 years until age 75 years. (GRADE of evidence: moderate; Strength of recommendation: weak) Prevention & Lifestyle Modification in Familial CRC o We recommend that individuals with LS should be advised that regular use of daily aspirin reduces CRC risk. (GRADE of evidence: moderate; Strength of recommendation: strong) o We suggest that people with LS should be offered research opportunities to take aspirin daily at different dosages. If they decline research (...) participation they may be advised on their choices regarding dose of aspirin, risks and benefits of long-term Aspirin use and ensure their medical practitioner is aware of their intake. (GRADE of evidence: low ; Strength of recommendation: weak) o There is insufficient evidence of the benefit of chemoprophylaxis in polyposis syndromes. (GRADE of evidence: moderate; Strength of recommendation: strong) o We suggest that individuals at increased familial risk of CRC should be strongly encouraged not to smoke

2019 British Society of Gastroenterology

74. Primary prevention of coronary heart disease in women

statement will examine the evidence regarding HRT and non-oestrogen therapies (lipid lowering agents, aspirin, antihypertensives, antidiabetic medications, SERMs) as well as diet, lifestyle and smoking cessation in the primary prevention of CHD in women. Summary practice points oestrogen may have a protective role in CHD prevention especially if initiated in women below age 60 years or within 10 years of onset of menopause women with a premature menopause should take oestrogen to reduce the risk of CHD (...) lipid-lowering agents are probably beneficial in primary prevention aspirin cannot be recommended for primary prevention of CHD, but may protect against stroke treating hypertension reduces the risk of CHD in diabetics, prevention of CHD is based on management of established cardiovascular risk factors through both lifestyle measures and pharmacotherapy in metabolic syndrome, prevention of CHD is based on management of established cardiovascular risk factors through both lifestyle measures

2019 British Menopause Society

75. Stroke, Diagnosis and Initial Treatment of Ischemic Stroke

combination therapy (eg, aspirin and clopidogrel) before stroke on the basis of evidence that the benefit of alteplase outweighs a probable increased risk of sICH. (Class I; LOE B-NR) Agree End-stage renal disease 1. In patients with end-stage renal disease on hemodialysis and normal aPTT, IV alteplase is recommended. (Class I; LOE C-LD) However, those with elevated aPTT may have elevated risk for hemorrhagic complications. Agree Contraindications (Class III) Time of onset 1. IV alteplase

2019 Institute for Clinical Systems Improvement

76. Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding

. Adolescents in whom a bleeding disorder has been diagnosed should be reminded that products that prevent platelet adhesion, such as aspirin or nonsteroidal antiinflammatory drugs, should be used only with the recommendation of a hematologist. In adolescents with known bleeding disorders, preoperative surgical evaluation, choice of hemostatic agents for control of intraoperative blood loss, and need for blood products should be determined in conjunction with a hematologist and an anesthesiologist (...) be reminded that products that prevent platelet adhesion, such as aspirin or nonsteroidal antiinflammatory drugs, should be used only with the recommendation of a hematologist ( ). Future Gynecologic and Reproductive Health Concerns In adolescents with known bleeding disorders, preoperative surgical evaluation, choice of hemostatic agents for control of intraoperative blood loss, and need for blood products should be determined in conjunction with a hematologist and an anesthesiologist. Vulvovaginal

2019 American College of Obstetricians and Gynecologists

78. Stillbirth care

· Offer smoking cessation program and support 49 · Offer referral and support for substance use (alcohol and drugs) Complications of pregnancy · Manage complications of pregnancy including fetal growth restriction, pre- eclampsia, antepartum haemorrhage and reduced fetal movements 19 · Advise low dose aspirin to women at high risk of abnormal placentation including pre-eclampsia 19,50,51 · Provide obstetric ultrasound assessment of fetal growth and umbilical artery Doppler studies to women with high

2019 Queensland Health

79. ASCIA Guidelines: Chronic Spontaneous Urticaria (CSU)

al, 2004; Erbagci, 2002). A number of head to head studies comparing montelukast with antihistamines favour antihistamines (Di Lorenzo et al, 2004; Godse, 2006; Nettis et al, 2001; Nettis et al, 2003). However, some studies have demonstrated efficacy of LTRAs in particular patient groups, notably; delayed pressure urticaria, cold urticaria, positive ASST and intolerance to aspirin or food additives (Pacor, Di Lorenzo & Corrocher, 2001; Bagenstose, Levin & Bernstein, 2004. Combination LTRA (...) and antihistamine therapy studies have demonstrated variable improvement in VAS, itch and urticarial scores at follow up ranging from three to six weeks (Wan, 2009; Wan & Chang, 2014; Bagenstose et al, 2004; Nettis et al, 2004). Long term data is lacking. Two further contradictory trials have, however, failed to demonstrate additional efficacy of combined therapy, in all but a small minority of patients, particularly when patients with positive ASST and intolerance to aspirin or food additives were excluded (Di

2019 Australasian Society of Clinical Immunology and Allergy

80. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk Full Text available with Trip Pro

Heart Attack (ALLHAT) trials. The recommendation for treatment with aspirin in this population has been eliminated due to a lack of sufficient evidence for its benefit. Subsequent data and a systematic review identified a relative risk (RR) reduction in nonfatal myocardial infarction (MI) but not in cardiovascular or all-cause mortality. The effects were modest and could be potentially outweighed by the risk of bleeding and other complications ( ). Dietary and exercise recommendations have been

2019 The Endocrine Society

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