Skip to main content
PMC home page
Gut logoLink to Gut
. 1994 Apr;35(4):464–466. doi: 10.1136/gut.35.4.464

Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment.

C P Choudari 1, C Rajgopal 1, K R Palmer 1
PMCID: PMC1374792  PMID: 8174982

Abstract

The underlying diagnosis and clinical course of 52 patients who presented with severe acute gastrointestinal haemorrhage while taking the anticoagulant warfarin is reviewed. A bleeding site was identified in 83% of cases, only slightly fewer than the 92% found in a control of group of 710 patients not taking warfarin who presented in the same four year period. The degree or duration of anticoagulation was unrelated to the frequency of establishing a diagnosis. The commonest diagnosis was peptic ulcer (25 cases) and endoscopic treatment by injection or heater probe was attempted in 23 of these. The outcome in this subgroup was compared with that in 50 closely matched control subjects who had similar risk factors for rebleeding from peptic ulcer. Permanent haemostasis was achieved in (91%) of the anticoagulated and in 92% of the control patients. There were no complications related to endoscopy. Patients who present with acute gastrointestinal haemorrhage while taking warfarin usually bleed from mucosal disease. They should be endoscoped after resuscitation and those with major bleeding from a peptic ulcer should be offered endoscopic treatment.

Full text

PDF
466

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chesebro J. H., Fuster V., Elveback L. R., McGoon D. C., Pluth J. R., Puga F. J., Wallace R. B., Danielson G. K., Orszulak T. A., Piehler J. M. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol. 1983 May 15;51(9):1537–1541. doi: 10.1016/0002-9149(83)90673-2. [DOI] [PubMed] [Google Scholar]
  2. Choudari C. P., Rajgopal C., Palmer K. R. Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage. Gut. 1992 Sep;33(9):1159–1161. doi: 10.1136/gut.33.9.1159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dale J., Myhre E., Loew D. Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement. Am Heart J. 1980 Jun;99(6):746–752. doi: 10.1016/0002-8703(80)90625-0. [DOI] [PubMed] [Google Scholar]
  4. Forfar J. C. A 7-year analysis of haemorrhage in patients on long-term anticoagulant treatment. Br Heart J. 1979 Aug;42(2):128–132. doi: 10.1136/hrt.42.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hull R., Hirsh J., Jay R., Carter C., England C., Gent M., Turpie A. G., McLoughlin D., Dodd P., Thomas M. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med. 1982 Dec 30;307(27):1676–1681. doi: 10.1056/NEJM198212303072704. [DOI] [PubMed] [Google Scholar]
  6. Landefeld C. S., Anderson P. A. Guideline-based consultation to prevent anticoagulant-related bleeding. A randomized, controlled trial in a teaching hospital. Ann Intern Med. 1992 May 15;116(10):829–837. doi: 10.7326/0003-4819-116-10-829. [DOI] [PubMed] [Google Scholar]
  7. Landefeld C. S., Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989 Aug;87(2):144–152. doi: 10.1016/s0002-9343(89)80689-8. [DOI] [PubMed] [Google Scholar]
  8. Landefeld C. S., Rosenblatt M. W., Goldman L. Bleeding in outpatients treated with warfarin: relation to the prothrombin time and important remediable lesions. Am J Med. 1989 Aug;87(2):153–159. doi: 10.1016/s0002-9343(89)80690-4. [DOI] [PubMed] [Google Scholar]
  9. Launbjerg J., Egeblad H., Heaf J., Nielsen N. H., Fugleholm A. M., Ladefoged K. Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients. J Intern Med. 1991 Apr;229(4):351–355. doi: 10.1111/j.1365-2796.1991.tb00358.x. [DOI] [PubMed] [Google Scholar]
  10. Levine M. N., Raskob G., Hirsh J. Hemorrhagic complications of long-term anticoagulant therapy. Chest. 1989 Feb;95(2 Suppl):26S–36S. doi: 10.1378/chest.95.2_supplement.26s. [DOI] [PubMed] [Google Scholar]
  11. Poller L. Laboratory control of oral anticoagulants. Br Med J (Clin Res Ed) 1987 May 9;294(6581):1184–1184. doi: 10.1136/bmj.294.6581.1184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Rajgopal C., Palmer K. R. Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer. Gut. 1991 Jul;32(7):727–729. doi: 10.1136/gut.32.7.727. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Tabibian N. Acute gastrointestinal bleeding in anticoagulated patients: a prospective evaluation. Am J Gastroenterol. 1989 Jan;84(1):10–12. [PubMed] [Google Scholar]
  14. Turpie A. G., Gunstensen J., Hirsh J., Nelson H., Gent M. Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet. 1988 Jun 4;1(8597):1242–1245. doi: 10.1016/s0140-6736(88)92070-3. [DOI] [PubMed] [Google Scholar]
  15. White R. H., McCurdy S. A., von Marensdorff H., Woodruff D. E., Jr, Leftgoff L. Home prothrombin time monitoring after the initiation of warfarin therapy. A randomized, prospective study. Ann Intern Med. 1989 Nov 1;111(9):730–737. doi: 10.7326/0003-4819-111-9-730. [DOI] [PubMed] [Google Scholar]
  16. Wilcox C. M., Truss C. D. Gastrointestinal bleeding in patients receiving long-term anticoagulant therapy. Am J Med. 1988 Apr;84(4):683–690. doi: 10.1016/0002-9343(88)90105-2. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES