Anticoagulants and antiplatelets during GI bleed🩸with the 👸 of #CardioGI herself, @NeenaSAbrahamMD!
#MedTwitter #GITwitter #ACG2022 #hematology #hemetwitter
#MedTwitter #GITwitter #ACG2022 #hematology #hemetwitter
Regardless of cardiovascular indication for AC/AP, GIB risk ⬆️ with AGE
⚠️Disparities in AC/AP prescribing: black, Hispanic, and women are ⬇️ likely to be appropriately prescribed
High mortality risk with GIB on AC/AP
⭐️AC management with GIB: it starts with recognizing SEVERITY of 🩸, because these may benefit from reversal agent
🚨Recognizing life-threatening hemorrhage
Warfarin reversal: PCC 🥇
❌Vitamin K (too slow)
When to restart warfarin? "The heart ALWAYS wins." 🫀Usually 4-7 days ok (low thrombotic risk)
❌Vitamin K (too slow)
When to restart warfarin? "The heart ALWAYS wins." 🫀Usually 4-7 days ok (low thrombotic risk)
Not much use for DOAC reversal agents, but *maybe* a role for PCC
When to restart DOAC? Not much data, but day after procedure seems safe in most (remember SHORT half life, so don't want to hold more than 48-72h!)
When to restart DOAC? Not much data, but day after procedure seems safe in most (remember SHORT half life, so don't want to hold more than 48-72h!)
Antiplatelet management in GIB
❌platelet transfusion (⬆️ mortality) UNLESS thrombocytopenic
❌stop aspirin for secondary prophylaxis
❌stop aspirin for secondary prophylaxis
@NeenaSAbrahamMD summary on management of anticoagulation and antiplatelets during GI bleed 🩸
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