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101. Antithrombotic drugs, patient characteristics, and gastrointestinal bleeding: Clinical translation and areas of research. Full Text available with Trip Pro

Antithrombotic drugs, patient characteristics, and gastrointestinal bleeding: Clinical translation and areas of research. Gastrointestinal bleeding (GIB) is a potentially fatal and avoidable medical condition that poses a burden on global health care costs. Current understanding of the roles of platelet activation and thrombin generation/activity in vascular medicine has led to the development of effective antithrombotic treatments. However, in parallel with a sustained coronary and cerebral (...) of illness, comorbidities) in whom it is used exert a greater impact on the risk of GIB than the type of antithrombotic agent employed. The latter concept argues for the occurrence of GIB as reflecting the presence of patients at the highest risk for adverse outcomes. The HAS-BLED score identifies subjects at risk of bleeding among those untreated and those treated with warfarin, DOACs and/or low-dose aspirin. Its use within the frame of a severity score (e.g., the CHA2DS2-VASc score in patients

2015 Blood reviews

102. Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial. Full Text available with Trip Pro

Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial. Gastrointestinal (GI) bleeding is a common complication of oral anticoagulation.This study evaluated GI bleeding in patients who received at least 1 dose of the study drug in the on-treatment arm of the ROCKET AF (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (...) -years vs. 0.04 events/100 patient-years; 1 fatal events vs. 5 fatal events total). Independent clinical factors most strongly associated with GI bleeding were baseline anemia, history of GI bleeding, and long-term aspirin use.In the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients

2015 Journal of the American College of Cardiology Controlled trial quality: predicted high

103. Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study. Full Text available with Trip Pro

Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study. Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested (...) the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72-2.50). In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03-3.57) and patients < 65 years old (AOR = 2.23; 95% CI, 1.56-3.18) had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[-] AMI[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65

2015 PloS one

104. Annual Risk of Major Bleeding Among Persons Without Cardiovascular Disease Not Receiving Antiplatelet Therapy. Full Text available with Trip Pro

Annual Risk of Major Bleeding Among Persons Without Cardiovascular Disease Not Receiving Antiplatelet Therapy. A decision to initiate aspirin therapy for primary prevention of cardiovascular disease (CVD) requires consideration of both treatment benefits and harms. The most significant harm associated with aspirin is major bleeding, yet there is a paucity of data on bleeding risk in suitable community populations.To determine the risk of major bleeding among people without CVD who (...) cohort; n=305 057) and after further excluding people receiving other medications associated with increased bleeding risk (nonmedication cohort; n=240 254).Sex and age group in 10-year bands from 30 to 79 years.Risk of a major bleeding event (hospitalization or death associated with bleeding); nonfatal gastrointestinal tract bleeding; and gastrointestinal tract bleeding-related case fatality.Mean participant age was 54 years (SD, 10 years), 44% were women, and 57% were European. Among the 359 166

2018 JAMA

105. Early time course of major bleeding on antiplatelet therapy after TIA or ischemic stroke Full Text available with Trip Pro

clopidogrel; rate ratio 1.94, 95% confidence interval 1.24-3.03 for aspirin plus dipyridamole). Incidence rates on aspirin and clopidogrel monotherapy were 2.8 and 2.5 per 100 person-years, respectively, in the first 30 days, with no significant change over time. The time course was similar for gastrointestinal bleeds. There was no early excess of intracranial hemorrhage in patients on either dual or single antiplatelet therapy.Dual antiplatelet therapy is associated with high early risks of major (...) Early time course of major bleeding on antiplatelet therapy after TIA or ischemic stroke To study the early time course of major bleeding and its subtypes in patients with cerebral ischemia on dual and single antiplatelet therapy.We performed a post hoc analysis on individual patient data from 6 randomized clinical trials (Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events [CAPRIE], Second European Stroke Prevention Study [ESPS-2], Management of Atherothrombosis With Clopidogrel

2018 EvidenceUpdates

106. Proton Pump Inhibitors for Gastrointestinal Conditions

- controlled trial. J Gastroenterol [Internet]. 2011 Jun [cited 2015 May 6];46(6):724-35. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117278. PubMed: PM21499703. Kellici I, Kraja B, Mone I, Prifti S. Role of intravenous omeprazole on non-variceal upper gastrointestinal bleeding after endoscopic treatment: a comparative study. Med Arh. 2010;64(6):324-7. PubMed: PM21218747 Ng FH, Wong SY, Lam KF, Chu WM, Chan P, Ling YH, et al. Famotidine is inferior to pantoprazole in preventing recurrence (...) Proton Pump Inhibitors for Gastrointestinal Conditions Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

107. No Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA. Full Text available with Trip Pro

of significant bleeding (gastrointestinal and wound bleeding) and mortality between low- and standard-dose aspirin within 90 days after surgery?We retrospectively evaluated 7488 patients in our database who underwent THA between September 2012 and December 2016. A total of 3936 (53%) patients received aspirin alone for VTE prophylaxis after THA. During the study period, aspirin was prescribed as a monotherapy for VTE prophylaxis after surgery in low-risk patients (no history of VTE, recent orthopaedic (...) ). The primary endpoint was symptomatic VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]). Secondary endpoints included significant bleeding (gastrointestinal [GI] and wound) and mortality. Exploratory univariate analyses were used to compare confounders between the study groups. Multivariate regression was used to control for confounding variables (including age, sex, body mass index, comorbidities, and surgeon) as we compared the study groups with respect to the proportion of patients who

2019 Clinical Orthopaedics and Related Research

108. Role of aspirin in primary prevention of cardiovascular disease. (Abstract)

bleeding. In the ARRIVE trial in people with multiple risk factors for cardiovascular disease, aspirin had no effect on major cardiovascular events but increased gastrointestinal bleeding. The aim of this Review is to place these new results in the context of previous evidence on aspirin for the primary prevention of cardiovascular disease and to appraise whether the new evidence is likely to enable the more targeted use of aspirin in particular individuals for whom the net benefit is both clinically (...) Role of aspirin in primary prevention of cardiovascular disease. The benefits of aspirin therapy for the secondary prevention of cardiovascular disease clearly outweigh the risks of bleeding, and low-dose aspirin is uniformly recommended in this setting. However, no clear consensus exists about whether, and if so in whom, aspirin therapy is appropriate for the primary prevention of cardiovascular disease. Three trials of low-dose aspirin versus placebo in three populations at increased risk

2019 Nature reviews. Cardiology

109. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Full Text available with Trip Pro

). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).Low-dose rivaroxaban taken twice a day plus aspirin once a day (...) reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.Bayer AG.Copyright © 2018 Elsevier Ltd

2017 Lancet Controlled trial quality: predicted high

110. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. (Abstract)

·03, p<0·0001), and similarly, more bleeds were seen in the rivaroxaban alone group than in the aspirin alone group (236 [3%] of 8250 vs 158 [2%] of 8261; HR 1·51, 95% CI 1·23-1·84, p<0·0001). The most common site of major bleeding was gastrointestinal, occurring in 130 [2%] patients who received combined rivaroxaban plus aspirin, in 84 [1%] patients who received rivaroxaban alone, and in 61 [1%] patients who received aspirin alone. Rivaroxaban plus aspirin reduced mortality when compared (...) than aspirin alone (347 [4%] of 8313 vs 460 [6%] of 8261; hazard ratio [HR] 0·74, 95% CI 0·65-0·86, p<0·0001). By comparison, treatment with rivaroxaban alone did not significantly improve the primary outcome when compared with treatment with aspirin alone (411 [5%] of 8250 vs 460 [6%] of 8261; HR 0·89, 95% CI 0·78-1·02, p=0·094). Combined rivaroxaban plus aspirin treatment resulted in more major bleeds than treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR 1·66, 95% CI 1·37-2

2017 Lancet Controlled trial quality: predicted high

111. The Protective Effect of Teprenone on Aspirin-Related Gastric Mucosal Injuries. Full Text available with Trip Pro

The Protective Effect of Teprenone on Aspirin-Related Gastric Mucosal Injuries. Aspirin usage is associated with increased risk of gastrointestinal bleeding. The present study explored the potential of teprenone, an antiulcerative, in preventing aspirin-related gastric mucosal injuries.280 patients with coronary diseases, naïve to aspirin medication, were admitted between 2011 and 2013 at the First Affiliated Hospital of Zhejiang Chinese Medical University and randomized into two groups (n (...) = 140). The aspirin group received aspirin enteric-coated tablets 100 mg/day, while the aspirin+teprenone group received teprenone 50 mg 3 times/day along with aspirin. The patients were recorded for gastrointestinal symptoms and gastric mucosal injuries during a follow-up period of 12 months with 3-month intervals.During the 3-month follow-up, no significant difference was observed in the incidence rate of gastrointestinal symptoms between the two groups (P = 0.498). However, the incidence rate

2019 Gastroenterology research and practice Controlled trial quality: uncertain

112. Aspirin in primary prevention: the triumph of clinical judgement over complex equations. (Abstract)

additive to that of statin, is counterbalanced by an excess of (mainly gastrointestinal) bleeding events. The signal for a net benefit seems to be even more controversial in the elderly starting aspirin after the age of 70 years. While international guidelines have promptly downgraded their recommendations to more conservative indications, the practicing clinician is called to make the effort to individualize the treatment, after careful evaluation of the haemorrhagic risk vis-a-vis the risk to develop (...) Aspirin in primary prevention: the triumph of clinical judgement over complex equations. Aspirin, in 2017, has celebrated its 120th birthday. The efficacy and safety of low-dose aspirin in secondary prevention of cardiovascular disease is well supported by many studies, instead in primary prevention it remains controversial, especially in the aftermath of the publication in 2018 of three novel primary prevention randomized clinical trials, showing that the benefit of low-dose aspirin, although

2019 Internal and emergency medicine

113. Aspirin and Primary Prevention in Patients with Diabetes-A Critical Evaluation of Available Randomized Trials and Meta-Analyses. (Abstract)

Aspirin and Primary Prevention in Patients with Diabetes-A Critical Evaluation of Available Randomized Trials and Meta-Analyses. Primary prevention of cardiovascular events with aspirin in patients with elevated cardiovascular risk, including diabetics, is currently under intense discussion. Data from meta-analyses suggests that the efficacy of aspirin in these patients is low, whereas there is a significantly increased bleeding tendency. However, meta-analyses are based on trials that differ (...) in many important aspects, including study selection. Fresh insights were expected from the ASCEND trial, by far the largest primary, randomized, placebo-controlled prevention trial in diabetics without known cardiovascular disease. There was a small but significant reduction in serious cardiovascular events by aspirin (8.6% vs. 9.6%) but also a significant increase in major bleeding: 4.1% versus 3.2%. Unfortunately, this trial did not meet the desired annual rate of elevated vascular risk of ≥ 2

2019 Thrombosis and haemostasis

114. Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data. Full Text available with Trip Pro

Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data. Aspirin impacts risk for important outcomes such as cancer, cardiovascular disease, and gastrointestinal bleeding. However, ascertaining exposure to medications available both by prescription and over-the-counter such as aspirin for research and quality improvement purposes is a challenge.Develop and validate a strategy for ascertaining aspirin exposure, utilizing a combination (...) of structured and unstructured data.This is a retrospective cohort study.In total, 1,869,439 Veterans who underwent usual care colonoscopy 1999-2014 within the Department of Veterans Affairs.Aspirin exposure and dose were obtained from an ascertainment strategy combining query of structured medication records available in electronic health record databases and unstructured data extracted from free-text progress notes. Prevalence of any aspirin exposure and dose-specific exposure were estimated. Positive

2019 Medical Care

115. Aspirin use in central retinal arterial occlusion to prevent ischaemic stroke: a retrospective cohort study in Taiwan. Full Text available with Trip Pro

groups 1 year after CRAO.Of the 3778 patients with newly diagnosed CRAO, 151 (4%) had a subsequent ischaemic stroke within 1 year. The risk was especially high during the first week of the CRAO. No difference between the aspirin and aspirin-naive groups was found in risk of ischaemic stroke, haemorrhagic stroke, gastrointestinal bleeding, major bleeding, acute coronary syndrome, retinal vein occlusion, new-onset glaucoma, undergoing panretinal photocoagulation or all-cause mortality. Risk factors (...) Aspirin use in central retinal arterial occlusion to prevent ischaemic stroke: a retrospective cohort study in Taiwan. To understand the efficacy of aspirin use for preventing ischaemic stroke after central retinal artery occlusion (CRAO).The retrospective cohort study was conducted using the National Health Insurance Research Database from 1998 to 2013.A population-based study.A total of 9437 participants with newly diagnosed CRAO were identified. Participants who had a previous stroke

2019 BMJ open

116. Should This Patient Receive Aspirin?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. (Abstract)

, cardiovascular disease mortality, or all-cause mortality, nor in total cancer mortality, among those taking aspirin. Aspirin users were found to be at increased risk for major gastrointestinal bleeding. In this Beyond the Guidelines, the guideline is reviewed and 2 experts discuss how they would apply it to a 57-year-old man considering starting aspirin for primary prevention. Our experts review the data on which the guideline is based, discuss how they would balance the benefits and harms of aspirin therapy (...) Should This Patient Receive Aspirin?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Aspirin exerts antiplatelet effects through irreversible inhibition of cyclooxygenase-1, whereas its anticancer effects may be due to inhibition of cyclooxygenase-2 and other pathways. In 2009, the U.S. Preventive Services Task Force endorsed aspirin for primary prevention of cardiovascular disease. However, aspirin's role in cancer prevention is still emerging, and no groups currently

2017 Annals of Internal Medicine

117. ASPIRE: Low?Dose Aspirin for Preventing Recurrent Venous Thromboembolism

ASPIRE: Low?Dose Aspirin for Preventing Recurrent Venous Thromboembolism RXFILES TRIAL SUMMARY MATTHEW SWANKHUIZEN – MAY 2013 – WWW.RXFILES.CA Page 1 of 2 ASPIRE: Low-Dose Aspirin for Preventing Recurrent Venous Thromboembolism 1 Aspirin to Prevent Recurrent Venous Thromboembolism BOTTOM LINE • In patients whom have had an unprovoked VTE with low to moderate bleed risk the addition of ASA 100 mg daily is reasonable to prevent future VTE events and major vascular events if the decision is made (...) , in supplemental material . POPULATION at baseline (n=822 over 2 years): Age ~54 ± 16 years; ~55% k ; index event DVT ~60 %; index event PE ~ 30 %; ~65 % anti-coagulated for 6 to 14 days TABLE 2 :WARFASA + ASPIRE POOLED EVENT ASPIRIN (n=616) PLACEBO (n=608) HR (95% CI) P-VALUE ARR/NNT COMMENTS Rate of recurrence of VTE 14% (n=85) 19% (n=116) 0.68 (0.51-0.90) 0.007 5%/20 Major Vascular events 16 % (n=98) 22 % (n=136) 0.66 (0.51-0.86) 0.002 6%/17 Clinically relevant bleeding 2.9% (n=18) 1.9% (n=12) 1.47 (0.70

2013 RxFiles

118. Cost-effectiveness of clopidogrel plus aspirin for stroke prevention in patients with atrial fibrillation in whom warfarin is unsuitable

that clopidogrel plus aspirin appeared to be cost-effective for patients at a high risk of ischaemic stroke and a low risk of major bleeding. There were some limitations in the reporting and the methods, and the authors' conclusions may not adequately reflect the uncertainty in the cost-effectiveness results. Type of economic evaluation Cost-utility analysis Study objective The objective was to assess the cost-effectiveness of clopidogrel plus aspirin for the prevention of stroke in patients with uncomplicated (...) atrial fibrillation, who were 65 years old, had a low risk of bleeding, and were unsuitable for warfarin. Patients had a Congestive heart failure, Hypertension, Age, Diabetes, and Stroke (CHADS 2 ) score of two. Interventions Clopidogrel, 75mg per day, plus aspirin, 75mg to 100mg per day, was compared with aspirin alone. Location/setting USA/out-patient secondary care. Methods Analytical approach: A Markov model was constructed of the ongoing risk of stroke, myocardial infarction and adverse events

2013 NHS Economic Evaluation Database.

119. Gastrointestinal Complications (PDQ®): Health Professional Version

Gastrointestinal Complications (PDQ®): Health Professional Version Gastrointestinal Complications (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf Warning: The NCBI web site requires JavaScript to function. Search database Search term Search NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. PDQ Cancer Information Summaries [Internet]. Bethesda (...) (MD): ; 2002-. Search term Gastrointestinal Complications (PDQ®) Health Professional Version PDQ Supportive and Palliative Care Editorial Board . Published online: November 28, 2018. This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the pathophysiology and treatment of gastrointestinal complications, including constipation, impaction, bowel obstruction, diarrhea, and radiation enteritis. It is intended as a resource

2018 PDQ - NCI's Comprehensive Cancer Database

120. 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

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