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21. Etiology and Long-term Rebleeding of Endoscopic Ulcerative Lesions in the Small Bowel in Patients with Obscure Gastrointestinal Bleeding: A Multicenter Cohort Study. (Abstract)

Etiology and Long-term Rebleeding of Endoscopic Ulcerative Lesions in the Small Bowel in Patients with Obscure Gastrointestinal Bleeding: A Multicenter Cohort Study. Among patients with obscure gastrointestinal bleeding (OGIB), endoscopic ulcerative lesions in the small bowel have diverse etiologies and often cause rebleeding. Certain characteristics of patients or ulcerations may be reasonable indications for diagnostic balloon-assisted endoscopy (BAE) to assess etiology and may be risks (...) , rebleeding occurred in 14 (21%) patients during a mean follow-up period of 17 months. Aspirin use and multiple ulcerations were significant predictors of rebleeding (P < 0.05).When we manage small bowel ulcerative lesions in OGIB patients, a single ulceration is a reasonable indication for the diagnostic BAE. The rebleeding rate was lower for single ulcerations than for multiple ulcerations.© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

2017 Journal of gastroenterology and hepatology

22. 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

23. Diagnosis and Management of Small Bowel Bleeding

Diagnosis and Management of Small Bowel Bleeding nature publishing group 1265 © 2015 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINES Bleeding from the small intestine remains a relatively uncom- mon event, accounting for ~5–10% of all patients presenting with gastrointestinal (GI) bleeding ( 1,2 ). Known previously as obscure GI hemorrhage (OGIB), we propose in this guideline that the former term referred to as OGIB be reclassifi ed (...) ,” “Meckel’s diverticulum,” ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding L a ur en B . G er s o n , MD , MS c, F A C G 1 , J eff L. Fidler , MD 2 , D a v id R . C a v e , MD , P hD , F A C G 3 a n d J o n a t h a n A. L eig h t o n , MD , F A C G 4 Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5–10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE

2015 American College of Gastroenterology

24. P2X1 ion channel deficiency causes massive bleeding in inflamed intestine and increases thrombosis. Full Text available with Trip Pro

stimulating factor (G-CSF) levels. Neutrophil depletion limited blood loss in these mice, whereas exogenous administration of G-CSF in colitic wild-type mice caused macrocytic anemia. Anemic colitic P2X1-deficient mice formed atypical neutrophil- and fibrin-rich, and platelet-poor thrombi upon arteriolar endothelial injury.Platelets and P2X1 ion channels are mandatory to preserve vascular integrity in inflamed intestine. Upon P2X1 deficiency, neutrophils contribute to bleeding and they may also (...) P2X1 ion channel deficiency causes massive bleeding in inflamed intestine and increases thrombosis. Intestinal inflammation is associated with bleeding and thrombosis, two processes that may involve both platelets and neutrophils. However, the mechanisms and the respective contribution of these cells to intestinal bleeding and extra-intestinal thrombosis remain largely unknown.Our study aimed at investigating the mechanisms underlying the maintenance of vascular integrity and thrombosis

2019 Journal of Thrombosis and Haemostasis

25. Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-dose Aspirin. Full Text available with Trip Pro

Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-dose Aspirin. There are few data on the incidence of upper and lower gastrointestinal bleeding (UGIB and LGIB) from observational studies of low-dose aspirin users. We aimed to estimate incidence rates of UGIB and LGIB in a large cohort of new users of low-dose aspirin in the United Kingdom, with subanalyses of hospitalization status and fatalities.We performed a population-based study of 199,079 new users of low-dose (...) , 0.72-0.82) for LGIB.In a population-based study of low-dose aspirin users, the incidence of LGIB was higher than the incidence of UGIB. However, incidence rates of hospitalized GI bleeds and 30-day mortality rates were lower for LGIB than for UGIB. These estimates are valuable for benefit-risk assessments of low-dose aspirin for cardiovascular and colorectal cancer prevention.Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

2018 Clinical Gastroenterology and Hepatology

26. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

and occurs much more frequently in the setting of thrombolysis. It has been suggested that hemorrhagic infarction is a result of multifocal red blood cell extravasation, whereas parenchymal hematoma is the a result of a single bleeding site in the blood vessel damaged by ischemia and reperfusion. Reperfusion of injured brain tissue, related to recanalization of the affected artery, provides the impetus for the development of hemorrhagic transformation. Recanalization of the affected artery, however (...) pressure at presentation, and severity of stroke at presentation (NIHSS); GWTG, Get With The Guidelines; HAT, Hemorrhage After Thrombolysis; MSS, Multicenter Stroke Survey; NIHSS, National Institutes of Health Stroke Scale; SEDAN, blood sugar, early infarct signs, hyperdense cerebral artery sign, age, NIHSS; SITS-ICH, Safe Implementation of Thrombolysis in Stroke–Intracranial Hemorrhage; SPAN, Stroke Prognostication Using Age and NIH Stroke Scale; and THRIVE, Totaled Health Risks in Vascular Events

2017 American Heart Association

27. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke

red blood cell extravasation, whereas parenchymal hematoma is the a result of a single bleeding site in the blood vessel damaged by ischemia and reperfusion. Reperfusion of injured brain tissue, related to recanalization of the affected artery, provides the impetus for the development of hemorrhagic transformation. Recanalization of the affected artery, however, is not the only determinant of the risk of hemorrhagic transformation, which can also occur with persistent occlusion, as noted (...) After Thrombolysis; MSS, Multicenter Stroke Survey; NIHSS, National Institutes of Health Stroke Scale; SEDAN, blood sugar, early infarct signs, hyperdense cerebral artery sign, age, NIHSS; SITS-ICH, Safe Implementation of Thrombolysis in Stroke–Intracranial Hemorrhage; SPAN, Stroke Prognostication Using Age and NIH Stroke Scale; and THRIVE, Totaled Health Risks in Vascular Events. Risk scores for sICH can be helpful for guiding patients’ and their families’ expectations and perhaps to inform

2017 American Academy of Neurology

28. Reintroduction of anti-thrombotic therapy after a gastrointestinal haemorrhage: if and when? Full Text available with Trip Pro

Reintroduction of anti-thrombotic therapy after a gastrointestinal haemorrhage: if and when? Gastrointestinal haemorrhage is a common clinical scenario and, in those using antithrombotic agents, the risk is significantly increased. Management of these patients, in terms of initial resuscitation is well established and numerous guidelines exist in this area. However, few studies have addressed the subsequent dilemma of if and when antithrombotic agents should be reintroduced. Consequently (...) , practice is variable and not necessarily evidenced-based. Overall, for patients that are either anticoagulated or using antiplatelet drugs for secondary prophylaxis, there is a clear benefit to restarting these agents. However, there is limited data to guide when this should occur. For individuals at low risk of re-bleeding, current guidelines suggest single agent aspirin can be continued without interruption, assuming haemostatic control has been confirmed endoscopically. For those at higher bleeding

2017 British journal of haematology

29. A Trial to Assess the Safety and Efficacy of Prophylactic TicagrelOr With Acetylsalicylic Acid Versus CLopidogrel With Acetylsalicylic Acid in the Development of Cerebrovascular EMbolic Events During TAVI

Vavouranakis, University of Athens Study Details Study Description Go to Brief Summary: Ticagrelor administered with Acetylsalicylic Acid (ASA) will provide better cerebral protection from microembolization in the cerebral circulation during Transcatheter Aortic Valve Implantation (TAVI) and 30 days afterwards, than Clopidogrel plus ASA. This hypothesis will be investigated by measuring the number of High Intensity Transient Signals (HITS) as assessed with transcranial Doppler (TCD) on middle cerebral (...) A Trial to Assess the Safety and Efficacy of Prophylactic TicagrelOr With Acetylsalicylic Acid Versus CLopidogrel With Acetylsalicylic Acid in the Development of Cerebrovascular EMbolic Events During TAVI A Trial to Assess the Safety and Efficacy of Prophylactic TicagrelOr With Acetylsalicylic Acid Versus CLopidogrel With Acetylsalicylic Acid in the Development of Cerebrovascular EMbolic Events During TAVI - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer

2016 Clinical Trials

30. Major Bleeding in Patients With Coronary or Peripheral Artery Disease Treated With Rivaroxaban Plus Aspirin Full Text available with Trip Pro

. Approximately one-third of major GI bleeding was gastric or duodenal, one-third was colonic or rectal, and one-third was from an unknown GI site. The study investigators reported that approximately three-quarters of major bleeding episodes were of mild or moderate intensity. A similar proportion of patients in each treatment group who experienced major bleeding received platelets, clotting factors, or other hemostatic agents.The combination of rivaroxaban and aspirin compared with aspirin alone increased (...) [9.2%] vs. 503 of 9,126 [5.5%]), (HR: 1.70; 95% CI 1.52 to 1.90; p < 0.0001); the combination also increased the need for any red cell transfusion (87 of 9,152 [1.0%] vs. 44 of 9,126 [0.5%]), (HR: 1.97; 95% CI 1.37 to 2.83, p = 0.0002). The gastrointestinal (GI) tract was the most common site of increased major bleeding (140 of 9,152 [1.5%] vs. 65 of 9,126 [0.7%]), (HR: 2.15; 95% CI: 1.60 to 2.89; p < 0.001), and the increase in bleeding was predominantly in the first year after randomization

2019 EvidenceUpdates

31. Acetylsalicylic acid and gastrointestinal bleeding measurement of blood loss using a modified radioactive chromium method. (Abstract)

Acetylsalicylic acid and gastrointestinal bleeding measurement of blood loss using a modified radioactive chromium method. A comparative study of the gastrointestinal blood loss during intake of a new buffered acetylsalicylic acid (ASA) preparation and plain ASA tablets has been performed. A modified radioactive chromium method was used. The 51Cr activity was considerably less than that used in previous methods, and no feces homogenization was necessary. The study was performed in 18 volunteers (...) using a randomized crossover design. A significant reduction in gastrointestinal bleeding was registered during ingestion of the buffered ASA in comparison with the plain ASA tablets.

1975 Scandinavian journal of gastroenterology Controlled trial quality: uncertain

32. Cost Effectiveness of Gastroprotection with Proton Pump Inhibitors in Older Low-Dose Acetylsalicylic Acid Users in the Netherlands. Full Text available with Trip Pro

Cost Effectiveness of Gastroprotection with Proton Pump Inhibitors in Older Low-Dose Acetylsalicylic Acid Users in the Netherlands. The present study aimed to assess the cost effectiveness of concomitant proton pump inhibitor (PPI) treatment in low-dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) adverse effects as compared with no PPI co-medication with attention to the age-dependent influence of PPI-induced adverse effects.We used a Markov model to compare (...) the strategy of PPI co-medication with no PPI co-medication in older LDASA users at risk of UGI adverse effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI adverse effects for LDASA users 60-69, 70-79 (base case) and 80 years and older. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life-year (QALY) gained per age category. Furthermore, a budget impact analysis assessed the expected changes in expenditure

2017 Drugs & Aging

33. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcome Full Text available with Trip Pro

stroke population.A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 (...) on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO

2017 EvidenceUpdates

34. To Evaluate the Bioavailability of a Single Oral Dose of the Acetylsalicylic Acid Containing Dry Powder 500 mg in Comparison to the Bioavailability of a Single Oral Dose of Aspirin Tablets and Aspirin Effervescent Tablets in Healthy Adults.

of gastrointestinal bleeding or perforation, including bleeding related to previous NSAID therapy. Active, or history of recurrent peptic ulcer/hemorrhage (two or more distinct episodes of proven ulceration or bleeding). Have taken ASA, ASA-containing products, acetaminophen or any other NSAID (OTC or prescription) seven days prior to dosing or during the Treatment Periods, other than study product Loss of blood in excess of 500 mL within 56 days of the first dose of trial treatment (e.g., donation (...) for: Arms and Interventions Go to Arm Intervention/treatment Experimental: Aspirin dry powder 500 mg Acetylsalicylic Acid (ASA) dry powder Drug: Aspirin (Acetylsalicylic acid, BAYe4465) One stick pack containing 500 mg acetylsalicylic acid dry powder Active Comparator: Aspirin coated tablet 500 mg ASA coated tablet Drug: Aspirin (Acetylsalicylic acid, BAYe4465) One tablet containing 500 mg acetylsalicylic acid Active Comparator: Aspirin effervescent tablet 500 mg ASA effervescent tablet Drug: Aspirin

2015 Clinical Trials

35. Acute upper gastrointestinal bleeding in over 16s: management

of bleeding and pre Control of bleeding and prev vention of re-bleeding in patients on NSAIDs, aspirin or clopidogrel ention of re-bleeding in patients on NSAIDs, aspirin or clopidogrel Continue low-dose aspirin for secondary prevention of vascular events in patients with upper gastrointestinal bleeding in whom haemostasis has been achieved. Acute upper gastrointestinal bleeding in over 16s: management (CG141) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms (...) /terms-and- conditions#notice-of-rights). Page 10 of 131.5.6 Offer TIPS if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate. 1.6 Control of bleeding and prevention of re-bleeding in patients on NSAIDs, aspirin or clopidogrel 1.6.1 Continue low-dose aspirin for secondary prevention of vascular events in patients with upper gastrointestinal bleeding in whom haemostasis has been achieved. 1.6.2 Stop other non-steroidal anti-inflammatory drugs (including

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

36. The risk of lower gastrointestinal bleeding in low-dose aspirin users. Full Text available with Trip Pro

The risk of lower gastrointestinal bleeding in low-dose aspirin users. Aspirin increases the risk of gastrointestinal bleeding.To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.Low-dose (75-325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed (...) to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine

2017 Alimentary Pharmacology & Therapeutics

37. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial. (Abstract)

is superior to a non-selective NSAID plus proton-pump inhibitor for prevention of recurrent ulcer bleeding in concomitant users of aspirin with previous ulcer bleeding.For this industry-independent, double-blind, double-dummy, randomised trial done in one academic hospital in Hong Kong, we screened patients with arthritis and cardiothrombotic diseases who were presenting with upper gastrointestinal bleeding, were on NSAIDs, and require concomitant aspirin. After ulcer healing, an independent staff member (...) randomly assigned (1:1) patients who were negative for Helicobacter pylori with a computer-generated list of random numbers to receive oral administrations of either celecoxib 100 mg twice per day plus esomeprazole 20 mg once per day or naproxen 500 mg twice per day plus esomeprazole 20 mg once per day for 18 months. All patients resumed aspirin 80 mg once per day. Both patients and investigators were masked to their treatments. The primary endpoint was recurrent upper gastrointestinal bleeding within

2017 Lancet Controlled trial quality: predicted high

38. Acetylsalicylic Acid (ASA) + Paracetamol + Caffeine Combination Compared With ASA + Paracetamol as Well as ASA, Paracetamol, and Caffeine in Headache Patients

Acetylsalicylic Acid (ASA) + Paracetamol + Caffeine Combination Compared With ASA + Paracetamol as Well as ASA, Paracetamol, and Caffeine in Headache Patients Acetylsalicylic Acid (ASA) + Paracetamol + Caffeine Combination Compared With ASA + Paracetamol as Well as ASA, Paracetamol, and Caffeine in Headache Patients - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record (...) Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Acetylsalicylic Acid (ASA) + Paracetamol + Caffeine Combination Compared With ASA + Paracetamol as Well as ASA, Paracetamol, and Caffeine in Headache Patients The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal

2014 Clinical Trials

39. Low-dose acetylsalicylic acid and gastrointestinal ulcers or bleeding--a cohort study of the effects of proton pump inhibitor use patterns. (Abstract)

Low-dose acetylsalicylic acid and gastrointestinal ulcers or bleeding--a cohort study of the effects of proton pump inhibitor use patterns. The aim of this study was to investigate the associations between proton pump inhibitor (PPI) usage patterns and risk of severe gastrointestinal events in patients treated with low-dose acetylsalicylic acid (LDA).A nationwide cohort study in Sweden.All Swedish residents ≥ 40 years of age, without cancer and receiving LDA treatment (≥ 80% adherence for 365 (...) 1.22 (95% CI 1.07-1.40)]. The risk of LDA treatment interruption was higher with intermittent PPI use [HR 1.16 (95% CI 1.14-1.19)] than continuous PPI use with high adherence.In this large cohort of LDA users, intermittent PPI use was associated with higher risk of gastrointestinal ulcers or bleeding and interrupted LDA treatment, compared with continuous PPI use.© 2013 The Association for the Publication of the Journal of Internal Medicine.

2013 Journal of internal medicine

40. Systematic review with meta analysis: Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding

Systematic review with meta analysis: Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time (...) disease but at a near equivalent risk of increased bleeding Article Text Therapeutics/Prevention Systematic review with meta analysis Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding Michael D Miedema 1 , Salim S Virani 2 Statistics from Altmetric.com Commentary on: Guirguis-Blake JM , Evans CV , Senger CA , et al . Aspirin for the primary prevention of cardiovascular events: a systematic evidence review

2016 Evidence-Based Medicine

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