Risk of GI bleed with an­ti­co­ag­u­lant

Penticton Herald - - LIVING - KEITH ROACH

DEAR DR. ROACH: Earlier this year, my 59-year-old brother was di­ag­nosed with atrial fib­ril­la­tion. He un­der­went a car­diover­sion suc­cess­fully, and the car­di­ol­o­gist put him on an anti-ar­rhyth­mia drug (amio­darone) and a blood thin­ner (Xarelto) in­def­i­nitely.

After four months, he suf­fered a ma­jor GI bleed event that hos­pi­tal­ized him. A colonoscopy showed only di­ver­tic­u­lo­sis, which they con­cluded was what caused the bleed­ing event. He was rec­om­mended for life­long med­i­ca­tion.

In your opin­ion, can a per­son with di­ver­tic­u­lo­sis safely be on a blood thin­ner like Xarelto with­out a ma­jor risk of GI bleed­ing?

Also, if the car­diover­sion got his heart beat­ing nor­mally again, and he is on an anti-ar­rhyth­mic drug, must he be on a blood thin­ner as well?

AN­SWER: There al­ways is a risk of a se­ri­ous GI bleed in some­one tak­ing an an­ti­co­ag­u­lant such as war­farin or one of the newer drugs, like Xarelto.

How­ever, for many peo­ple, there is less risk of a ma­jor bleed than there is of a stroke, so that’s why it’s crit­i­cally im­por­tant to look at an in­di­vid­ual’s par­tic­u­lar risk.

One tool for do­ing so is the CHA2DS2-VASc (pro­nounced “chads-vasc”) score, which es­ti­mates the risk for stroke in some­one with atrial fib­ril­la­tion.

Peo­ple with an el­e­vated score are rec­om­mended for an­ti­co­ag­u­la­tion with an an­ti­co­ag­u­lant; those at lower risk usual are treated with as­pirin.

This does not look at the risk of bleed­ing, but a his­tory of di­ver­tic­u­lo­sis is not con­sid­ered a ma­jor risk for bleed­ing.

For most peo­ple with a high CHA2DS2VASc score, an­ti­co­ag­u­la­tion will have more ben­e­fit than harm. More than 80 per cent of peo­ple who had a stroke with atrial fib­ril­la­tion were not get­ting the rec­om­mended treat­ment.

For peo­ple with atrial fib­ril­la­tion and a high CHA2DS2-VASc score, the bal­ance of risks and ben­e­fits clearly is on the side of an­ti­co­ag­u­la­tion, as a stroke is dev­as­tat­ing.

Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslet­ters.

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