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81. Antepartum Haemorrhage

of this guideline, the following definitions have been used: Spotting – staining, streaking or blood spotting noted on underwear or sanitary protection Minor haemorrhageblood loss less than 50 ml that has settled Major haemorrhageblood loss of 50–1000 ml, with no signs of clinical shock Massive haemorrhageblood loss greater than 1000 ml and/or signs of clinical shock. Recurrent APH is the term used when there are episodes of APH on more than one occasion. 3. Identification and assessment (...) haemorrhage’, ‘fetomaternal hemorrhage’, ‘antenatal bleeding’, ‘pregnancy’, ‘disseminated intravascular coagulopathy’, and the search limited to humans and the English language. The National Library for Health and the National Guidelines Clearing House were also searched for relevant guidelines and reviews (with no results). Guidelines and recommendations produced by organisations such as NHS Health Trusts were therefore considered. Where possible, recommendations are based on available evidence

2011 Royal College of Obstetricians and Gynaecologists

82. Randomised controlled trial: Addition of omeprazole to dual antiplatelet therapy with clopidogrel plus aspirin lowers the risk of upper gastrointestinal bleeding

Randomised controlled trial: Addition of omeprazole to dual antiplatelet therapy with clopidogrel plus aspirin lowers the risk of upper gastrointestinal bleeding Addition of omeprazole to dual antiplatelet therapy with clopidogrel plus aspirin lowers the risk of upper gastrointestinal 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. To learn more about (...) the risk of upper gastrointestinal bleeding Article Text Therapeutics Randomised controlled trial Addition of omeprazole to dual antiplatelet therapy with clopidogrel plus aspirin lowers the risk of upper gastrointestinal bleeding Jolanta M Siller-Matula 1 , Georg Delle-Karth 1 Statistics from Altmetric.com Commentary on: Bhatt DL , Cryer BL , Contant CF , et al. ; COGENT Investigators . Clopidogrel with or without omeprazole in coronary artery disease. Context Antiplatelet therapy represents

2011 Evidence-Based Medicine

83. Management of Bleeding in Patients on Oral Anticoagulants

If$1 of the following factors apply, the bleed is classi?ed as major. Bleeding in a Critical Site Criticalsitebleedsareconsideredbleedsthatcompromise the organ’s function. Intracranial hemorrhage and other central nervous system bleeds (e.g., intraocular, spinal) and thoracic, intra-abdominal, retroperitoneal, intra- articular, and intramuscular bleeds are considered critical as they may cause severe disability and require surgical procedures for hemostasis. Intraluminal gastrointestinal (GI (...) ¼ atrial ?brillation; GI¼ gastrointestinal. Tomaselli et al. JACC VOL. -,NO. -,2017 2017 ACC ECDP on Management of Bleeding in Patients on Oral Anticoagulants -,2017:-–- 18Gastrointestinal Bleeding (GI Bleeding) GI bleeding is a relatively common hemorrhagic compli- cation of chronic OAC therapy. Anticoagulant therapy is permanently discontinued in a substantial proportion of patients despite evidence of bene?twithreinitiatingthe OAC. In a systematic review of observational studies, patients with OAC

2017 American College of Cardiology

84. Risk of major bleeding and stroke associated with the use of vitamin K antagonists, nonvitamin K antagonist oral anticoagulants and aspirin in patients with atrial fibrillation: a cohort study Full Text available with Trip Pro

use with Cox regression analysis.A total of 31 497 patients were eligible for the study. The hazard ratio (HR) of major bleeding was 2.07 [95% confidence interval (CI) 1.27-3.38] for NOACs compared with VKAs, which was mainly attributed by the increased risk of gastrointestinal bleeding (HR 2.63, 95% CI 1.50-4.62). This increased bleeding risk was restricted to women (HR 3.14, 95% CI 1.76-5.60). Aspirin showed a similar bleeding risk as VKAs. NOACs showed equal effectiveness as VKA in preventing (...) ischaemic stroke (HR 1.22, 95% CI 0.67-2.19). VKAs were more effective than aspirin (HR 2.18, 95% CI 1.83-2.59).NOACs were associated with a higher risk on gastrointestinal bleeding, particularly in women. The use of NOACs in patients who are vulnerable for this type of bleeding should be carefully considered. NOACs and VKAs are equally effective in preventing stroke. Aspirin was not effective in the prevention of stroke in AF.© 2017 The British Pharmacological Society.

2017 British journal of clinical pharmacology

85. Incidence of intracranial bleeds in new users of low-dose aspirin: a cohort study using The Health Improvement Network. Full Text available with Trip Pro

aspirin use.Background Low-dose aspirin protects against both ischemic cardiovascular (CV) events and colorectal cancer (CRC). However, low-dose aspirin may be associated with a slightly increased risk of intracranial bleeds (ICBs). Objectives To obtain the incidence rates of ICBs overall and by patient subgroups among new users of low-dose aspirin. Patients/Methods Using The Health Improvement Network (THIN) UK primary-care database (2000-2012), we identified a cohort of new users of low-dose aspirin (...) Incidence of intracranial bleeds in new users of low-dose aspirin: a cohort study using The Health Improvement Network. Essentials Intracranial bleeds (ICB) are serious clinical events that have been associated with aspirin use. Incidence rates of ICB were calculated among new-users of low-dose aspirin in the UK (2000-2012). Over a median follow-up of 5.58 years, the incidence of ICB was 0.08 per 100 person-years. Our estimates are valuable for inclusion in risk-benefit assessments of low-dose

2017 Journal of Thrombosis and Haemostasis

86. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Full Text available with Trip Pro

given 30 - 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper (...) Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage

2015 Endoscopy

87. Evaluate Misoprostol for the Healing of Small Bowel Ulcers in Low-dose Aspirin Users Complicated by Small Bowel Bleeding

has not yet been confirmed by prospective randomized trials. This double-blind clinical trial tests the hypothesis that misoprostol can heal small bowel ulcers in Aspirin users complicated by small bowel bleeding. Condition or disease Intervention/treatment Phase Ulcer Hemorrhage Drug: Misoprostol Drug: Placebo Phase 2 Phase 3 Detailed Description: ASA is the most commonly drug used worldwide for prevention of cardiovascular diseases. However, ASA is increasingly recognized as a culprit for small (...) bowel bleeding. The latter condition manifests as overt bleeding (i.e., passing black or bright red stool) or occult blood loss (i.e., normal stool but progressive decrease in hemoglobin level), with normal findings in the stomach and colon. Small bowel bleeding is notoriously difficult to diagnose because it is beyond the reach of conventional endoscopy. The advent of wireless, video capsule endoscopy has revolutionized the visualization of small bowel. Capsule endoscopy is a pill that contains

2013 Clinical Trials

88. Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding Full Text available with Trip Pro

Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding To compare outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) taking aspirin for primary prophylaxis to those not taking it.Patients not known to have any vascular disease (coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital (...) mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two groups.Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics (control group). Patients in the aspirin group were

2016 World journal of gastrointestinal surgery

89. Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin. Full Text available with Trip Pro

Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin. It is not clear whether H2-receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper GI bleeding and ulcers in high-risk (...) famotidine (3.1%; 95% CI, 1.2%-8.1%) (P = .16). The composite end point of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%-14.7%) and 13 patients receiving famotidine (12.4%; 95% CI, 7.4%-20.4%) (P = .26).In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients

2016 Gastroenterology Controlled trial quality: predicted high

90. Gastro-intestinal microbleeding under acetylsalicylic acid, ketoprofen and placebo. (Abstract)

Gastro-intestinal microbleeding under acetylsalicylic acid, ketoprofen and placebo. A quantitative comparison of gastro-intestinal microbleeding induced by acetylsalicylic acid (ASA), 3.6 g daily, ketoprofen (KETO), 200 mg daily and placebo (P) was undertaken in 12 normal volunteers using a double-blind factorial design with repeated measures. We conclude that KETO induces less gastro-intestinal bleeding than ASA but more than placebo and that there is a significant residual bleeding under (...) placebo following ASA.

1976 Rheumatology and rehabilitation

91. Guidelines for the management of aneurysmal subarachnoid hemorrhage

normal head CT and cerebrospinal fluid test results, as shown in a recent study in which 1.4% of patients were diagnosed with aSAH only after vascular imaging techniques were used. 94 Patients may report symptoms consistent with a minor hemorrhage before a major rupture, which has been called a sentinel bleed or warning leak. 83,84 The majority of these minor hemorrhages occur within 2 to 8 weeks before overt aSAH. The headache associated with a warning leak is usually milder than that associated (...) that CTA may not reveal small aneurysms and that 2- and 3-dimensional cerebral angiography should be performed, especially when the hemorrhage is accompanied by loss of consciousness. 110 In cases of diffuse aSAH pattern, most agree that negative CTA should be followed by 2- and 3-dimensional cerebral angiography. In older patients with degenerative vascular diseases, CTA can replace catheter cerebral angiography in most cases if the image quality is excellent and analysis is performed carefully. 111

2012 American Academy of Neurology

92. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

normal head CT and cerebrospinal fluid test results, as shown in a recent study in which 1.4% of patients were diagnosed with aSAH only after vascular imaging techniques were used. 94 Patients may report symptoms consistent with a minor hemorrhage before a major rupture, which has been called a sentinel bleed or warning leak. 83,84 The majority of these minor hemorrhages occur within 2 to 8 weeks before overt aSAH. The headache associated with a warning leak is usually milder than that associated (...) that CTA may not reveal small aneurysms and that 2- and 3-dimensional cerebral angiography should be performed, especially when the hemorrhage is accompanied by loss of consciousness. 110 In cases of diffuse aSAH pattern, most agree that negative CTA should be followed by 2- and 3-dimensional cerebral angiography. In older patients with degenerative vascular diseases, CTA can replace catheter cerebral angiography in most cases if the image quality is excellent and analysis is performed carefully. 111

2012 Congress of Neurological Surgeons

93. New clinical paradigms for treating and preventing antiplatelet gastrointestinal bleeding. (Abstract)

New clinical paradigms for treating and preventing antiplatelet gastrointestinal bleeding. To quantify antiplatelet-related gastrointestinal bleeding (GIB), characterize patients at greatest risk and summarize risk-management strategies emphasizing evolving knowledge in acute management of antiplatelet-related bleeding.New paradigms for acute management of antiplatelet-related GIB exist in the domains of resuscitation and the transfusion of blood products, strategic use of proton pump therapy (...) and identification and eradication of Helicobacter pylori. This review will also highlight the importance of prompt resumption of cardiac aspirin and dual antiplatelet therapy following endoscopic hemostasis to minimize the risk of future cardiac events.This review will provide pragmatic strategies for the management of acute antiplatelet-related GIB. Emerging areas of clinical knowledge will be addressed and knowledge gaps requiring further research to inform clinical practice will be highlighted.

2017 Current opinion in gastroenterology

94. Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants. (Abstract)

selected a control group of 296 patients with gastrointestinal bleeding who were not receiving anticoagulation treatment from the same sample. Outcomes included the need for hospitalization, blood transfusion, endoscopic or surgical intervention, and 30-day mortality.The DOAC and warfarin groups were similar in terms of age and underlying comorbidity (assessed using the Charlson Comorbidity Index), but the DOAC group had greater concomitant aspirin use. Gastrointestinal bleeding was classified as upper (...) (n = 186), lower (n = 88), anorectal (n = 183), small bowel (n = 9), and indeterminate (n = 14). After adjusting for differences in baseline variables, the DOAC group had fewer hospitalizations and required fewer transfusions than the warfarin group. The DOAC and control groups were not statistically different for all outcomes. There were no significant mortality differences among groups.Although prior studies have shown a higher frequency of gastrointestinal bleeding in patients treated

2017 American Journal of Medicine

95. Lower Gastrointestinal Bleeding in Patients with Coronary Artery Disease on Antithrombotics and Subsequent Mortality Risk. (Abstract)

Lower Gastrointestinal Bleeding in Patients with Coronary Artery Disease on Antithrombotics and Subsequent Mortality Risk. Lower gastrointestinal bleeding (LGIB) is a common complication for patients with coronary artery disease (CAD) due to the use of antithrombotic medications. Limited data exist describing which patients are at increased risk for mortality.This study aims to (i) determine whether patients on dual antiplatelet therapy (DAPT) or triple therapy are at higher risk of 90-day (...) and 6-month mortality compared with patients on aspirin alone and (ii) evaluate risk factors for mortality in patients with CAD on antithrombotics hospitalized with LGIB.We conducted a retrospective cohort study of patients hospitalized with LGIB and CAD while on aspirin at a single academic medical center from 2007 to 2015. Patients were identified using a validated, machine-learning algorithm and classified by use of aspirin, DAPT, or triple therapy. Univariate and multivariate Cox proportional

2017 Journal of gastroenterology and hepatology

96. Prognostic Significance of Elevated Cardiac Troponin in Acute Gastrointestinal Bleeding Full Text available with Trip Pro

Prognostic Significance of Elevated Cardiac Troponin in Acute Gastrointestinal Bleeding Acute gastrointestinal bleeding (AGIB) is responsible for over 140,000 hospitalizations annually. Cardiovascular-related deaths account for 30% of the patients surviving the initial episode of AGIB. The purpose of this study was to identify the impact of elevated troponin on short-term mortality and length of stay (LOS) of these patients.From July 2013 to July 2016, 290 patients admitted with a diagnosis (...) , 21% died in the same period (6/29, P = 0.001). The LOS was also higher in patients with troponin elevation (6 vs. 5 days, P = 0.02). There was no difference in 30-day readmission among the two groups. Past history of coronary artery disease, congestive heart failure, hypertension, aspirin use and elevated creatinine was more common in patients with troponin elevation. On multivariate analysis, troponin elevation on presentation is associated with increased mortality (odds: 5.50, CI: 1.73 - 17.47

2017 Gastroenterology research

97. NSAID-related upper gastrointestinal bleeding: Types of drug use and patient profiles in real clinical practice. (Abstract)

recent use (<30 days) of NSAIDs including high-dose acetylsalicylic acid (ASA). NSAID use was associated with increased risk of upper GI bleeding, with an adjusted relative risk of 4.86 (95% CI, 4.32-5.46). Acute musculoskeletal pain (36.1%), chronic osteoarthritis (13.5%), and headache (13.6%) were the most common reasons for NSAID use. Among cases, only 17.31% took NSAIDs and 6.38% took high dose ASA due to chronic osteoarthritis. Demographic characteristics significantly differed between subjects (...) NSAID-related upper gastrointestinal bleeding: Types of drug use and patient profiles in real clinical practice. The best available evidence regarding non-steroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) bleeding comes from randomized controlled trials including patients who use NSAIDs to manage chronic rheumatic diseases; however, patients with varying background profiles commonly take NSAIDs for many other reasons, often without prescription, and such usage has not been

2017 Current medical research and opinion

98. Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide Population-Based Cohort Study. Full Text available with Trip Pro

Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide Population-Based Cohort Study. Cyclooxygenase-2 inhibitors (coxibs) are associated with less upper gastrointestinal bleeding (UGIB) than traditional nonsteroidal anti-inflammatory drugs (tNSAIDs). However, they also increase the risk of UGIB in high-risk patients. We aimed to identify the risk factors of UGIB in coxibs users.Retrospective cohort study.2000-2010 National Health Insurance (...) , acetylsalicylic acid, or thienopyridines.Among coxibs users, H. pylori infection and history of PUB were especially important risk factors for UGIB. Further studies are needed to determine whether proton pump inhibitors might play a protective role in these at-risk patients.© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

2017 Pain Medicine

99. Transverse Colostomy for Refractory Hemorrhagic Chronic Radiation Proctitis: a Prospective Cohort Study

of pelvic radiation; No tumor recurrence or metastasis; Refractory hemorrhagic CRP; Time of rectal bleeding >6 months; SOBS≥2 points; Moderate to severe anemia (Hb≤9 g/dl). Exclusion Criteria: Severe complications of CRP, including deep ulcer or fistula, stricture, necrosis, refractory perianal pain; Other hemorrhagic diseases, like III-IV degree hemorrhoids; History of colon or rectum resection; Intestinal obstruction and surgery needed; with contraindications to general anaesthesia (ASA class 4 or 5 (...) Affiliated Hospital, Sun Yat-sen University: chronic radiation proctitis rectal bleeding transverse colostomy refractory moderate to severe anemia Additional relevant MeSH terms: Layout table for MeSH terms Anemia Hemorrhage Proctitis Hematologic Diseases Pathologic Processes Gastroenteritis Gastrointestinal Diseases Digestive System Diseases Rectal Diseases Intestinal Diseases

2017 Clinical Trials

100. Tranexamic Acid for Spontaneous Acute Cerebral Hemorrhage Trial

later, at 24 hours and at 1 week. Condition or disease Intervention/treatment Phase Stroke Hemorrhagic Intracerebral Haemorrhage Drug: Tranexamic Acid Phase 3 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 220 participants Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: Randomised placebo-controlled parallel group clinical trial Masking: Double (Participant, Outcomes Assessor (...) Processes Intracranial Hemorrhages Cerebrovascular Disorders Brain Diseases Central Nervous System Diseases Nervous System Diseases Vascular Diseases Cardiovascular Diseases Tranexamic Acid Antifibrinolytic Agents Tranylcypromine Fibrin Modulating Agents Molecular Mechanisms of Pharmacological Action Hemostatics Coagulants Antidepressive Agents Psychotropic Drugs Monoamine Oxidase Inhibitors Enzyme Inhibitors Anti-Anxiety Agents Tranquilizing Agents Central Nervous System Depressants Physiological

2017 Clinical Trials

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