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Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy
AbstractAntiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase...
Source: Indian Journal of Gastroenterology - June 5, 2023 Category: Gastroenterology Source Type: research

Algorithmic anticoagulation: streamlining the decision to hold and restart blood thinners in the periendoscopy period
The number and complexity of procedures performed by gastroenterologists are increasing in the United States.1,2 In addition, the number and complexity of antithrombotic agents are growing.3 These concurrent trends may lead to confusion among providers on the  appropriate management of these drugs during endoscopy. The skilled clinician must balance the risks of thrombosis, including myocardial infarction and stroke, against the risks of procedure-related hemorrhage, which can be potentially fatal.
Source: Gastrointestinal Endoscopy - November 20, 2019 Category: Gastroenterology Authors: Theodore W. James, Todd H. Baron Tags: Original article Source Type: research

Paradoxical Cerebral Embolism after Gastrointestinal Endoscopy in a Patient with Crohn's Disease
We describe a patient with Crohn's disease who developed paradoxical cerebral embolism after GE. Both an unstable venous thrombus in the superior vena cava and RLS through patent foramen ovale were thought to be responsible for the stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - February 28, 2018 Category: Neurology Authors: Hajime Ikenouchi, Naoto Sugeno, Takaaki Nakamura, Junpei Kobayashi, Ryuji Oshima, Hiroshi Kuroda, Masashi Aoki Tags: Case Studies Source Type: research

Not as Simple as Canker Sores
BY ​NANA P. MATSUMOTO, & DEREK MEEKS, DO​​A 16-year-old boy presented to a rural ED with a swollen jaw, painful blisters in the mouth, and earache for the past day. One week before, he had a fever with chills, sore throat, and dry coughs. He was not taking any medications, and his immunizations were up-to-date. He had a mild learning disorder but no significant past medical or surgical history.​An apthous ulcer, the most common and one of the earliest signs of Behçet's disease.The patient's vital signs were within normal limits, and his physical examination revealed anterior cervical lymphadenopathy, sinus con...
Source: The Case Files - October 11, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Endoscopy in Patients on Antiplatelet Agents and Anticoagulants
Opinion statementManagement of patients on anticoagulant or antiplatelet therapy undergoing endoscopy presents a balance of risks between haemorrhage due to the procedure, and thrombosis due to discontinuation of antithrombotic therapy. Haemorrhage is usually controllable endoscopically, but thrombosis could, on occasion, result in myocardial infarction or stroke, with permanent disability or death. For elective procedures, there is adequate time to plan best management of antithrombotic therapy. International guidelines have been published, but recommendations are based on limited evidence and consultation with appropriat...
Source: Current Treatment Options in Gastroenterology - May 25, 2017 Category: Gastroenterology Source Type: research

Mo1086 Severity of Gastrointestinal Bleeding in Patients Treated With Direct-Acting Oral Anticoagulants (Doacs)
Direct-acting oral anticoagulants (DOACs), which have recently been approved for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics and lack of required monitoring. DOACs have been shown to be associated with an increased frequency of gastrointestinal bleeding (GIB) compared to warfarin, but the severity of GIB in these patients is poorly understood.
Source: Gastrointestinal Endoscopy - April 28, 2017 Category: Gastroenterology Authors: Mark M. Brodie, Tyler Smith, Jill Newman, Don C. Rockey Tags: Monday – ASGE poster Source Type: research

Mo1074 Outcomes of Gastrointestinal Hemorrhage in the Setting of Novel Versus Traditional Antithrombotic Agents
The objective of our study was to compare outcomes among patients presenting with GI bleed that were prescribed novel versus traditional antithrombotic agents.
Source: Gastrointestinal Endoscopy - April 28, 2017 Category: Gastroenterology Authors: Jonathan I. Chang, Elizabeth Dong, Karl Kwok, Bechien U. Wu Tags: Monday – ASGE poster Source Type: research

Case Report: Acute Cerebellar Thrombosis in an Adult Patient with IgM Nephropathy.
We describe a patient who presented with nonspecific symptoms of epigastric pain, nausea, and early satiety. Abdominal imaging and endoscopies were unremarkable. She was found to have significant proteinuria (6.4 g/24 hours), hyperlipidemia, and edema consistent with a diagnosis of nephrotic syndrome. Kidney biopsy was performed and confirmed an IgM nephropathy. Less than 2 weeks after her diagnosis of IgM nephropathy, she presented with an acute cerebellar stroke. Thrombophilia is a well-known complication of nephrotic syndrome, but a review of the literature failed to show an association between IgM nephropathy and acute...
Source: Methodist DeBakey Cardiovascular Journal - September 30, 2015 Category: Cardiology Authors: Adike A, Cherry M, Awar M Tags: Methodist Debakey Cardiovasc J Source Type: research

An Unusual Cause Of Recurrent Ischemic Stroke: Trousseau's Syndrome From Gastric Cancer (P4.231)
CONCLUSIONS: Trousseau’s Syndrome must be considered in those presenting with recurrent strokes with an otherwise negative embolic work up especially in the elderly and those with cancer risk factors. It must prompt the clinician to look for an associated malignancy.Disclosure: Dr. JADEJA has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Soetanto has nothing to disclose. Dr. Nalleballe has nothing to disclose. Dr. DeNiro has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Graber has received personal compensation for activities with Stemedica Inc., Novocure Inc., and Biogen Idec.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Jadeja, N., Johnson, J., Soetanto, A., Nalleballe, K., DeNiro, L., Qureshi, I., Graber, J. Tags: Neuro-oncology: Paraneoplastic Disorders Source Type: research

Intraluminal Cell Transplantation Prevents Growth and Rupture in a Model of Rupture-Prone Saccular Aneurysms Basic Sciences
Conclusions— Lack of smooth muscle cells in the aneurysm wall promotes wall degradation, aneurysm growth and rupture, even if the aneurysm is occluded by luminal thrombus. Transplantation of smooth muscle cells into the luminal thrombus can reduce this degenerative remodeling.
Source: Stroke - November 24, 2014 Category: Neurology Authors: Marbacher, S., Frosen, J., Marjamaa, J., Anisimov, A., Honkanen, P., von Gunten, M., Abo-Ramadan, U., Hernesniemi, J., Niemela, M. Tags: Animal models of human disease, Arterial thrombosis, Other Vascular biology Basic Sciences Source Type: research

P-001 High-Resolution Optical and Angiographic CT Imaging of Flow-Diverter Stents for Assessment of Vessel Wall Apposition
Conclusion Due to its superior in-plane resolution, OCT clearly visualised the distinction between the vessel wall and the FD stent struts. Nevertheless, our example showed that VasoCT enables identification of apposition distances in the order of 0.5mm. Although OCT is clinically used in interventional cardiology, its neurovascular application is currently limited to the experimental setting. Here we showed that OCT can provide a gold-standard for the validation of VasoCT assessments of FD apposition. References Pierot L, Wakhloo AK. Stroke 2013;44:2046–2054 Kizilkilic O, et al. J Neurosurg 2012;117:45–49 F...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: van der Marel, K., Gounis, M., King, R., Wakhloo, A., Puri, A. Tags: Oral poster abstracts Source Type: research

Loss of Mural Cells Leads to Wall Degeneration, Aneurysm Growth, and Eventual Rupture in a Rat Aneurysm Model Basic Sciences
Conclusions— In the presented experimental setting, complete loss of mural cells acts as a driving force for aneurysm growth and rupture. The findings suggest that aneurysms missing mural cells are incapable to organize a luminal thrombus, leading to recanalization, increased inflammatory reaction, severe wall degeneration, and eventual rupture.
Source: Stroke - December 23, 2013 Category: Neurology Authors: Marbacher, S., Marjamaa, J., Bradacova, K., von Gunten, M., Honkanen, P., Abo-Ramadan, U., Hernesniemi, J., Niemela, M., Frosen, J. Tags: Basic Sciences Source Type: research

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