Management dilemmas in restarting anticoagulation after gastrointestinal bleeding

Abstract

Systemic anticoagulants are widely prescribed to prevent and treat thromboembolism, among other indications. A common com-plication of using these agents is gastrointestinal bleeding. While early resumption of anticoagulants after the bleeding has resolved can increase the risk of rebleeding, delayed resumption puts the patient at increased risk of thromboembolic events and mortality. There is limited data on this topic to guide clinicians on resuming anticoagulation after hospitalization for gastrointestinal bleeding and to educate patients regarding the subsequent risks of recurrent gastrointestinal bleeding, thromboembolism, and mortality. The optimal time to resume anticoagulation is also unknown. This review summarizes the existing literature and available data on the commonly encountered dilemma of restarting anticoagulation therapy after hospitalization for gastrointestinal bleeding.

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Faculty credentials/disclosure 

Dr. Jain is an internal medicine resident at SUNY Upstate Medical University. Dr. Singh isan internal medicine resident at Saint Vincent Hospital, Worcester, Massachusetts. Dr. Kaul is chief of the Division of Pulmonary Medicine and attending physician in critical care medicine at Crouse Health. He is also associate program director of the pulmonary and critical care medicine fellowship and assistant professor of medicine at Upstate Medical University. Dr. Gambhir is vice chair for quality improvement and patient safety, Department of Medicine; associate program director, Internal Medicine Residency Program; and associate professor and hospitalist, SUNY Upstate Medical University. The authors and planner for this educational activity have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.

Process

Click the take course button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.
  • By claiming ABIM MOC credit you are providing permission to have your data uploaded into the Accreditation Council for Continuing Medical Education (ACCME) system for transfer to the American Board of Internal Medicine (ABIM).

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Expiration date

Credit eligibility for this article is set to expire on May 1, 2024.

Target Audience

All physicians

Learning Objectives

After completing the article, the learner should be able to:

  • Formulate an opinion regarding the optimal timing of anticoagulation therapy resumption after gastrointestinal tract bleeding
  • Discuss the outcomes of mortality, recurrent gastrointestinal tract bleeding, and thromboembolism in patients who have resumed anticoagulation therapy after gastrointestinal tract bleeding versus patients who have not resumed anticoagulation therapy after gastrointestinal tract bleeding
Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
05/01/2022
Course expires: 
05/01/2024
Cost:
$25.00
Rating: 
0

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Internal Medicine Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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