Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-BO_Abraham Anticoagulant and Antiplatelet Drugs in Clinical Scenarios Like a Pro

BO_Abraham Anticoagulant and Antiplatelet Drugs in Clinical Scenarios Like a Pro

Pdf Summary

Dr. Neena S. Abraham from the Mayo Clinic provides insights into managing anticoagulant and antiplatelet drugs in common clinical scenarios. One specific case discussed involves a 76-year-old male patient with ischemic heart disease and atrial fibrillation, who is on Apixaban and aspirin therapy. He presents with gastrointestinal bleeding after taking NSAIDs, showing symptoms like faintness, dizziness, and dark, tarry stools. His hemoglobin and hematocrit levels are significantly low, indicating acute blood loss. He is stabilized with blood transfusions and fluids, and the GI service is alerted for further intervention.<br /><br />Key management strategies emphasize the careful resumption of anticoagulant and antiplatelet therapy after gastrointestinal bleeding (GIB). For instance, if aspirin used for secondary prevention is interrupted, it should be resumed within 24 hours after successful endoscopic hemostasis to reduce mortality risk. The document also suggests routine platelet transfusion for significant GIB, especially if platelet count is below 100,000, though it notes increased mortality associated with GIB.<br /><br />Further clinical insights include the assessment of warfarin and direct oral anticoagulants (DOAC) resumption post-GIB, and the consideration of prophylactic measures like clipping to prevent post-polypectomy bleeding. It discusses the risks associated with polypectomy and anticoagulation therapy, emphasizing a new approach termed “the cold revolution” that reduces the risk of bleeding.<br /><br />The document stresses the importance of multidisciplinary discussions and individualized patient care to balance the risks of bleeding and thromboembolism. This includes reevaluating the use of aspirin for primary prevention due to its low cardiovascular benefits compared to the high risk of gastrointestinal bleeding. Dr. Abraham's expert guidance highlights the complex decision-making required to manage patients on anticoagulant and antiplatelet therapy safely and effectively.

Keywords

anticoagulant therapy

antiplatelet management

gastrointestinal bleeding

ischemic heart disease

atrial fibrillation

DOAC resumption

endoscopic hemostasis

multidisciplinary care

thromboembolism risk

Dr. Neena S. Abraham