Gastrointestinal bleeding and the prevention of thromboembolism

Abstract

About 2 percent of developed countries population use vitamin K antagonists (VKA), such as warfarin. These anticoagulation drugs are commonly prescribed for the purpose of thromboembolism prevention, in cases of atrial fibrillation, mechanical heart valves, deep vein thrombosis, pulmonary embolism and etc. The frequency of VKA prescription is massively increasing in the whole world. The main reason for it is the ageing of the population. As the usage of anticoagulants is increasing, doctors more often get to encounter patients with gastrointestinal bleeding taking anticoagulating drugs. The treatment of these patients is difficult because there are several important factors that have to be considered while choosing the tactic of treatment, such as the intensity of bleeding, coagulation, thrombotic risk and endoscopic findings. Even if practical guidelines partially indicate the main principles of actions for similar cases, the treatment of bleeding patients taking anticoagulants remains seriously challenging. This article contains clinical case report and the discussion of the treatment that has been chosen in this case, based on practical guidelines provided by American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Cardiology (ESC). This topic is also addressed in guidelines from the American College of Gastroenterology, the American College of Chest Physicians, the American College of Cardiology, which give similar recommendations.