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aspirin and gastrointestinal bleeding


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7481. A Study to Evaluate the Efficacy and Safety of Tapentadol (CG5503) in the Treatment of Acute Pain After Abdominal Hysterectomy

an abdominal hysterectomy with or without bilateral salpingo-oophorectomy due to uterine leiomyomas, or dysfunctional uterine bleeding or endometrial hyperplasia; Anesthesiological and surgical procedures performed according to protocol; Moderate or severe baseline pain following hysterectomy on a Verbal Rating Scale (VRS) within 6 hours following the last possible application of morphine subcutaneous; Pain following hysterectomy of at least 4 on an 11-point Numeric Rating Scale (NRS) within 6 hours (...) following the last possible application of morphine subcutaneous; American Society of Anesthesiologists (ASA) classification I-III. Exclusion Criteria: Vaginal hysterectomy; Ongoing or known history of painful endometriosis; Known or suspected chronic pelvic pain syndrome; Previous abdominal or pelvic open surgery; History of seizure disorder or epilepsy; History of alcohol or drug abuse; Evidence of active infections that may spread to other areas of the body; severely impaired renal function

2007 Clinical Trials

7482. Intraocular Pressure During Abdominal Aortic Aneurysm (AAA) Repair

vascular resistance, cardiac output, and acid base status. These physiologic changes are further pronounced with more proximal cross-clamping and longer duration. Because infrarenal abdominal aortic aneurysms are the most common type of AAA repair, we will be assessing IOP with patients undergoing elective infrarenal abdominal aortic reconstruction. Infrarenal aortic cross clamping is associated with increases in venous return, central venous pressure and arterial blood pressure (15). The hemodynamic (...) and cardiopulmonary bypass (12,13,14). However, there has been no literature evaluating intraocular pressure during abdominal aortic aneurysm (AAA) repair. AAA repair is a high-risk surgery associated with blood loss, hypotension and has been reported in a case series associated with ION (6). The surgery involves clamping and unclamping of the aorta to facilitate excision of the aneurysm and graft repair. Aortic cross clamping and unclamping is an intense physiologic insult affecting venous return, systemic

2007 Clinical Trials

7483. Optimal Multimodal Analgesia in Abdominal Hysterectomy

Optimal Multimodal Analgesia in Abdominal Hysterectomy Optimal Multimodal Analgesia in Abdominal Hysterectomy - Full Text View - 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. Optimal Multimodal Analgesia in Abdominal (...) Information provided by: Hvidovre University Hospital Study Details Study Description Go to Brief Summary: The purpose of this study is to test the current standard of care (SOC) treatment for abdominal hysterectomy with a group receiving SOC minus epidural analgesia plus additional perioperative analgesics in terms of postoperative abilities, postoperative nausea and vomiting (PONV), pain and discharge time from the PACU (post-anaesthesia care unit). Condition or disease Intervention/treatment Phase

2005 Clinical Trials

7484. Safety and Efficacy of Multiple Doses of Intranasal Ketorolac in Postoperative Pain Following Major Abdominal Surgery

: No Criteria Inclusion Criteria: Men or women age 18 through 64 years Major abdominal surgery Body weight ≥ 100 and ≤ 300 pounds Negative serum pregnancy test Pain intensity score at least 40 (moderate pain) on 100 mm visual analog scale Minimum 48 hour hospital stay and 5 day maximum stay Able to provide written informed consent Willing and able to comply with all testing requirements of the protocol Exclusion Criteria: Allergy or sensitivity to ketorolac or ethylene diamine tetraacetic acid (EDTA (...) or gastrointestinal bleeding Advanced renal impairment or risk for renal failure History of other medical problems that could interfere with the study participation Pregnancy or breastfeeding Participation in another investigational study within past 30 days Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its

2005 Clinical Trials

7485. Combined vs. Isoflurane/Fentanyl anesthesia for major abdominal surgery: Effects on hormones and hemodynamics. (Abstract)

anesthesia.Sixty ASA I-II patients were prospectively randomized to receive either combined anesthesia, i.e, isoflurane anesthesia combined with thoracic epidural analgesia (bolus of 12 ml 0.2% ropivacaine containing 1 microg/ml sufentanil 30 min before incision, followed by continuous infusion at 6 ml/h) or isoflurane/fentanyl anesthesia (IV fentanyl as required) for major abdominal surgery. Depth of anesthesia was monitored using Bispectral Index. Administration of fluids and of vasopressors was directed (...) by a standardized protocol. Blood samples for angiotensin II, vasopressin, catecholamines, and cortisol were drawn before anesthesia, after induction (but before using the epidural catheter), and 40 min after skin incision.After induction of anesthesia, mean arterial pressure decreased by 12-20 mmHg in both groups and angiotensin-II concentrations increased. Vasopressin increased predominantly after opening the abdomen in both groups. Under combined anesthesia, intraoperative epinephrine and cortisol

2008 Medical science monitor : international medical journal of experimental and clinical research Controlled trial quality: uncertain

7486. Does Prior Abdominal Surgery Influence Conversion Rates and Outcomes of Laparoscopic Right Colectomy in Patients with Neoplasia? (Abstract)

cm.Patients with prior abdominal surgery (n = 191) were compared with patients with no prior abdominal surgery (n = 223), and showed no significant differences in age, ASA classification, length of stay, operative time, blood loss, harvested nodes, tumor size, and specimen length. Significantly more wound infections occurred in the prior abdominal surgery group (22 vs.12, P = 0.023). Body mass index > 30 showed a three-fold increased risk of conversion. Fifteen percent of the no prior abdominal surgery (...) Does Prior Abdominal Surgery Influence Conversion Rates and Outcomes of Laparoscopic Right Colectomy in Patients with Neoplasia? The study investigated the impact of prior abdominal surgery on conversions and outcomes of laparoscopic right colectomy.A consecutive series of 414 patients with cancer or adenomas who underwent a laparoscopic right colectomy from March 1996 to November 2006 were studied for surgical conversions and outcomes. Conversion was defined as an incision length > 7

2008 Diseases of the Colon & Rectum

7487. Does clopidogrel rather than aspirin plus a proton-pump inhibitor reduce the frequency of gastrointestinal complications after cardiac surgery?

that day the endoscopist reviews the patient and suggests that aspirin and lansoprazole would be safer and cheaper too. You resolve to check this in the literature. Search Strategy Medline 1966-November 2006 using the OVID interface. [] AND [exp Aspirin/ OR] AND [exp Gastrointestinal Hemorrhage/ OR gastrointestinal bleed$.mp OR exp Peptic Ulcer Hemorrhage/ OR exp Peptic Ulcer Perforation/ OR exp Duodenal Ulcer/ OR exp Peptic Ulcer Hemorrhage/ OR exp Peptic Ulcer (...) / OR Gastrointestinal OR exp Stomach Ulcer/ ]] Search Outcome A total of 40 papers were found. All relevant papers had their reference list crosschecked. From this search six papers were deemed to represent the best evidence on the topic. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Chan et al, 2005, Hong Kong 320 patients with previous GI bleeding on cardiovascular aspirin dose, and endoscopically proven ulcer healing, H

2007 BestBETS

7488. Clopidogrel and the Optimization of Gastrointestinal Events (COGENT-1)

by: Cogentus Pharmaceuticals Study Details Study Description Go to Brief Summary: The purpose of the COGENT-1 clinical trial is to determine whether CGT-2168 (clopidogrel and omeprazole) compared to clopidogrel is safe and effective in reducing the incidence of gastrointestinal bleeding and symptomatic ulcer disease, in the setting of concomitant aspirin therapy. Antiplatelet therapy is an essential element of care for patients with atherothrombotic disease. Bleeding is a fundamental adverse effect of all (...) antiplatelet drugs including aspirin, clopidogrel and dual antiplatelet regimens. The gastrointestinal tract is the most common site of bleeding related to antiplatelet therapy, typically in connection with peptic ulcer disease. Recently published studies suggest the use of clopidogrel carries a gastrointestinal bleeding risk similar to that of aspirin or non-aspirin non-steroidal anti-inflammatory drugs. Patients taking any two of these drugs (clopidogrel, aspirin and/or non-aspirin NSAIDs) are exposed

2007 Clinical Trials

7489. A Study of Avastin (Bevacizumab) in Combination With Chemotherapy in Patients With Endocrine Tumors of the Gastrointestinal Tract.

) Primary Purpose: Treatment Official Title: An Open Label Study to Evaluate the Effect of Avastin in Association With Chemotherapy on Progression-free Survival in Patients With Progressive Advanced/Metastatic Well-differentiated Digestive Endocrine Tumors of the Gastrointestinal Tract Study Start Date : July 2007 Actual Primary Completion Date : November 2011 Actual Study Completion Date : November 2011 Arms and Interventions Go to Arm Intervention/treatment Experimental: 1 Drug: bevacizumab [Avastin (...) Volunteers: No Criteria Inclusion Criteria: adult patients, >=18 years of age; well-differentiated gastrointestinal tract endocrine tumors, or duodeno-pancreatic endocrine tumors; no previous anti-cancer therapy, other than surgery; progressive metastatic disease; >=1 measurable lesion. Exclusion Criteria: abnormal cardiac function, with history of ischemic heart disease in past 6 months and/or abnormal 12 lead ECG; patients with known bleeding disorders; unstable systemic disease; chronic daily

2007 Clinical Trials

7490. Gastrointestinal Ulceration in Patients on Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Volunteers: No Criteria Inclusion Criteria: Patients who have undergone PCI within the preceding 72 hrs Patients on aspirin and clopidogrel Age greater than 18 years and less than 80 years Written informed consent Exclusion Criteria: Active bleeding Pregnancy Patients already on H2 antagonists Patients already on PPI Patients with implanted cardiac defibrillator (ICD) Patients with GI strictures, swallowing disorders, or bowel obstruction and fistulas. Patients with significant gastrointestinal (...) , gastric, or duodenal ulcerations. [ Time Frame: 90 Days ] Overt GI symptoms include GI bleeding requiring hospitalization, blood transfusion, and/or interventions like endoscopy or surgery or gastroesophageal acid reflux (GERD) requiring acid-suppressive therapy. [ Time Frame: 90 Days ] Occult GI ulcerations and erosions include those detected by capsule endoscopy (PillCamÒ ESO) within 80 to 90 days after initiation of dual antiplatelet therapy. [ Time Frame: 90 Days ] Eligibility Criteria Go

2006 Clinical Trials

7491. Avastin and Tarceva for Upper Gastrointestinal Cancers

of need for major surgical procedure during the curse of the study o Minor surgical procedures, fine needle aspirations or core biopsies within 7 days prior to treatment History of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 6 month prior to treatment Any ongoing infection, uncontrolled diabetes mellitus, serious non-healing wound or ulcer Pregnancy or breast feeding Ongoing therapeutic anti-coagulation Hypertension with blood pressure > 150/100 mmHg Contacts (...) ) or preservatives. Fertile males must use preservatives. Exclusion Criteria: Radiotherapy or chemotherapy within the last 4 weeks Co-medication that may interfere with study results; e.g. immuno-suppressive agents other than corticosteroids Any prior EGFR- or VEGFR-based therapy Any condition (medical, social, psychological), which would prevent adequate information and follow-up Tumor located close to major blood vessels and judged to possess a high risk of serious bleeding Any other active malignancy, except

2006 Clinical Trials

7492. Reduced incidence of upper gastrointestinal ulcer complications with the COX-2 selective inhibitor, valdecoxib. (Abstract)

% (three of 1472 patient-years) for non-aspirin users.Valdecoxib, including above recommended doses, is associated with a significantly lower rate of upper gastrointestinal ulcer complications than therapeutic doses of non-selective non-steroidal anti-inflammatory drugs.Copyright 2004 Blackwell Publishing Ltd (...) Reduced incidence of upper gastrointestinal ulcer complications with the COX-2 selective inhibitor, valdecoxib. In a predefined analysis, data were pooled from eight blinded, randomized, controlled trials, and separately from three long-term, open-label trials to determine the rate of upper gastrointestinal ulcer complications with the cyclo-oxygenase-2 selective inhibitor, valdecoxib, vs. non-selective non-steroidal anti-inflammatory drugs.In randomized, controlled trials, 7434 osteoarthritis

2004 Alimentary pharmacology & therapeutics

7493. Prospective randomized controlled trial of acute normovolaemic haemodilution in major gastrointestinal surgery. (Full text)

of a transfusion protocol reduced the transfusion rate in colorectal patients from 136/333 (41%) to 37/138 (27%), P=0.004.In this large pragmatic study, ANH did not affect allogeneic transfusion rate in major gastrointestinal surgery. Preoperative haemoglobin, blood loss, and transfusion protocol are the key factors influencing allogeneic transfusion. (...) of allogeneic units transfused (90 vs 93), complication rate, or duration of stay. Haemodilution significantly increased anaesthetic time, median 55 (range 15-90) vs 40 min (range 17-80) (P<0.001). Significantly fewer patients in the ANH group experienced oliguria in the immediate postoperative period 37/78 (47%) vs 55/82 (67%) (P=0.012). The most significant factors affecting transfusion were blood loss, starting haemoglobin, and age. When compared with ASA-matched historical controls, the introduction

2004 British Journal of Anaesthesia Controlled trial quality: uncertain PubMed abstract

7494. Role of nitric oxide in the gastrointestinal tract (Full text)

Role of nitric oxide in the gastrointestinal tract Worldwide osteoarthritis (OA) affects more than 9.6% of men and 18% of women older that 60 years. Treatment for OA often requires chronic use of selective or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), which have been associated with gastrointestinal and cardiovascular complications. An increased risk for upper gastrointestinal bleeding with NSAIDs alone and when combined with low-dose aspirin has been described in numerous (...) adherence to the endothelium, and to repair NSAID-induced damage. In addition, epidemiologic studies have shown that the use of NO-donating agents with NSAIDs or aspirin resulted in reduced risk for gastrointestinal bleeding. Recent studies have shown that cyclo-oxygenase inhibiting NO-donating drugs (CINODs), in which a NO molecule is chemically linked to an NSAID, are effective anti-inflammatory agents and may result in less gastrointestinal damage than is associated with NSAID use. Therefore

2008 Arthritis research & therapy PubMed abstract

7495. Inappropriate prevention of NSAID-induced gastrointestinal events among long-term users in the elderly. (Abstract)

Inappropriate prevention of NSAID-induced gastrointestinal events among long-term users in the elderly. Although use of NSAIDs and aspirin (acetylsalicylic acid) is well known to be associated with gastrointestinal (GI) complications and potential mortality, these medications continue to be widely prescribed in the elderly. Age is a significant risk factor for NSAID-induced GI events; indeed, patients >75 years of age carry the highest risk and are similar in this respect to patients (...) or misoprostol. Over 30% of patients are non-adherent and the lowest rate of non-adherence is associated with the first NSAID prescription, which increases the risk of ulcer bleeding compared with those who are fully adherent. Predictors of nonadherence include long-term use of NSAIDs and a high average daily dose of NSAIDs. Predictors of adherence include a history of upper gastrointestinal events, anticoagulant use, rheumatological disease and use of low-dose salicylates, among others. Another important

2007 Drugs & Aging

7496. Gastrointestinal Considerations in Patients with Cardiovascular Disease Using Nonopioid Analgesics for Mild-to-Moderate Pain or Cardioprotection. (Abstract)

, and the highest risk exists among the elderly and patients with a history of GI bleeding or complications. The increasingly widespread use of aspirin for both primary and secondary cardiovascular prophylaxis has also drawn attention to the potential increase in GI complications. Several strategies may minimize NSAID-mediated GI complications, including the use of drugs that do not injure the gut, such as acetaminophen or a low-dose opiate. The cyclooxygenase-2 (COX-2) inhibitors, which cause approximately 50 (...) Gastrointestinal Considerations in Patients with Cardiovascular Disease Using Nonopioid Analgesics for Mild-to-Moderate Pain or Cardioprotection. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of medications worldwide, available both through prescription and over the counter (OTC). Although these drugs are highly effective for pain, gastrointestinal (GI) complications may occur. Risk factors for GI complications from NSAIDs have been well studied

2006 American Journal of Cardiology

7497. Familial Polyposis of the Colon

[ ] . The location of the mutation on the gene is thought to influence the nature of the extra-colonic manifestations. Presentation Adenomas usually begin to develop during the second decade of life. Unfortunately, it often presents with colorectal cancer. The median age at diagnosis is 40 years [ ] . Symptoms Patients are often asymptomatic but may present with rectal bleeding, diarrhoea, abdominal pain and mucous discharge [ ] . Obstruction may cause constipation, vomiting and peritonitis. Dental abnormalities (...) Complications secondary to polyps lining the colon include: Gastrointestinal haemorrhage. Gastrointestinal obstruction. Malignant change (if prophylactic colectomy is not performed). The risk of colorectal cancer increases with the number of polyps: The mean age of colon cancer diagnosis in untreated individuals is 35-40 years [ ] . Patients with more than 1,000 polyps have been proven to have 2.3 times the cancer risk compared to patients with fewer than 1,000 polyps. Prognosis Colon cancer will develop

2008 Mentor

7498. Abdominal Aortic Aneurysms

proteolysis and smooth muscle cell loss. The dilatation affects all three layers of the arterial wall. A false aneurysm (pseudoaneurysm) is caused by blood leaking through the arterial wall but contained by the adventitia or surrounding perivascular tissue. The 'normal' diameter of the abdominal aorta is approximately 2 cm; it increases with age. An abdominal aneurysm is usually defined as an aortic diameter of 3 cm or greater. Most abdominal aortic aneurysms (AAAs) arise from below the level of the renal (...) and extent of bleeding. Retroperitoneal haemorrhage may cause Grey Turner's sign, ie flank bruising. Investigations [ ] This covers the non-urgent scenario. Investigations aim to evaluate the detailed anatomy of the aneurysm, any treatable causes and the patient's fitness for surgery: Blood tests: FBC, clotting screen, renal function and liver function. Cross-match if surgery is planned. ESR and/or CRP if an inflammatory cause is suspected. ECG, CXR and possibly lung function tests. Scans: [ ] Ultrasound

2008 Mentor

7499. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding: H. pylori eradication therapy

D. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding: H. pylori eradication therapy. Health Technology Assessment 2007; 11(51): 67-74 PubMedID Original Paper URL Other publications of related interest Leontiadis GI, Sreedharan A, Dorward S, Barton P, Delaney B, Howden CW, Orhewere M, Gisbert J, Sharma VK, Rostom A, Moayyedi P & Forman D. Systematic reviews of the clinical effectiveness and cost-effectiveness (...) of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technology Assessment 2007;11(51):1-145. Indexing Status Subject indexing assigned by NLM MeSH Acute Disease; Aged; Anti-Inflammatory Agents, Non-Steroidal /adverse effects /therapeutic use; Congresses as Topic; Cost-Benefit Analysis; Databases, Bibliographic; Duodenal Ulcer /complications; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage /drug therapy /economics /prevention & Helicobacter Infections /drug therapy

2007 DARE.

7500. Single antiplatelet therapy for patients with previous gastrointestinal bleeds (Full text)

antiplatelet therapy and a proton pump inhibitor was required. Funding Not stated. Bibliographic details Gellatly RM, Ackman ML. Single antiplatelet therapy for patients with previous gastrointestinal bleeds. Annals of Pharmacotherapy 2008; 42(6): 836-840 PubMedID DOI Other URL Indexing Status Subject indexing assigned by NLM MeSH Aged; Aspirin /adverse effects /therapeutic use; Cardiovascular Diseases /prevention & Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage /chemically induced; Humans (...) Single antiplatelet therapy for patients with previous gastrointestinal bleeds Single antiplatelet therapy for patients with previous gastrointestinal bleeds Single antiplatelet therapy for patients with previous gastrointestinal bleeds Gellatly RM, Ackman ML CRD summary This review compared efficacy of aspirin plus proton pump inhibitor versus clopidogrel in patients with a previous gastrointestinal bleed who required single antiplatelet therapy. The authors concluded that limited literature

2008 DARE. PubMed abstract

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