Deans' stroke musings: Use of anticoagulation or antiplatelet agents not linked to higher risk of GI bleeding in patients hospitalized with COVID-19

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, January 2, 2021

Use of anticoagulation or antiplatelet agents not linked to higher risk of GI bleeding in patients hospitalized with COVID-19

So does this contradict this research?

But this research below suggests not due to bleeding risks. I'll take that risk since I've been on warfarin, aspirin and had Lovenox shots.

COVID-Related Strokes Especially Severe, Result in Worse Outcomes

The paragraph from there:

"On the other hand, in most patients with COVID-19 associated ischaemic stroke, very early anti-coagulation is probably not warranted as a strategy to prevent inpatient stroke recurrence, as this outcome is too uncommon to justify the increased risk of secondary haemorrhage," according to the group.(So you wait until the clots are severe before you do anti-coagulation. OK, not for me.)

You doctor better know the EXACT PROTOCOL to prevent these complications.

The latest here:

Use of anticoagulation or antiplatelet agents not linked to higher risk of GI bleeding in patients hospitalized with COVID-19

Use of anticoagulation or antiplatelet agents were not risk factors for gastrointestinal (GI) bleeding in patients hospitalized with coronavirus disease 2019 (COVID-19), according to a study published in the Journal of Internal Medicine. The study also found that patients who developed GI bleeding during hospitalization had increased mortality.

Arvind J Trindade, MD, Northwell Health, Manhasset, New York, and colleagues conducted a propensity score matched case-control study of adult patients with COVID-19 admitted to Northwell Health System between March 1 and April 27, 2020.

“In this analysis of over 11,000 patients in New York, which once served as the epicenter of the COVID-19 pandemic, we found a 3% rate of gastrointestinal bleeding with 104 who presented with GI bleeding on admission and 210 who developed GI bleeding during hospitalization,” the researchers reported.

Of 314 patients with GI bleeding, most (68%) had upper GI bleeds, with a mean hemoglobin of 8.4 g/dL. Among patients with GI bleeding, 20 (6%) underwent endoscopy. The most common etiology for bleeding found on endoscopy was gastroduodenal ulceration.

COVID-19 patients with a GI bleed on admission and COVID-19 patients who developed a GI bleed during their hospitalization were respectively matched 1:1 to COVID-19 patients without bleeding using a propensity score that took into account comorbidities, demographics, GI bleeding risk factors, and length of stay.

The researchers found that the use of anticoagulation medication (P = 0.5109), antiplatelet agents (P = 0.6774), steroids (P = 0.6384), and non-steroidal anti-inflammatory drugs (P = 0.1083) were not associated with increased risk of GI bleeding in COVID-19 patients. Additionally, proton pump inhibitors (P = 0.0614) and histamine receptor blockers (P = 0.4456) were not associated with a protective effect against the development of GI bleeding.

Further, patients who developed a GI bleed during the hospitalization were found to have an increased mortality (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.06-2.34; P = 0.02) compared with those who did not develop GI bleeding during hospitalization. There was no statistically significant between-group difference observed in the need for mechanical ventilation (OR 1.34; 95% CI, 0.88-2.04; P = 0.17). On the other hand, no difference in mortality (OR, 0.62; 95% CI 0.31-1.24; P = 0.17) or need for mechanical ventilation (OR, 0.50; 95% CI, 0.21-1.17; P = 0.10) was found between patients admitted with a GI bleed and those without GI bleeding on admission.

“Despite the push to treat severe COVID-19 patients with anticoagulation therapy, the risks are not well understood,” the authors wrote. “Given observational studies showing severe GI bleeding in COVID-19 patients, it is unclear if this is a consequence of this therapy.”

“It was surprising that anticoagulation was not associated with an increased risk for GI bleeding in the hospitalized COVID-19 population,” the authors noted. “This study is reassuring given anticoagulation is being prescribed to critically ill hospitalized COVID-19 patients. Further prospective research from the randomized trials described above could provide more insight regarding this.”

Reference: https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.13232

SOURCE: Journal of Internal Medicine