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Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. | LitMetric

AI Article Synopsis

  • Acute lower gastrointestinal bleeding (LGIB) is a major cause for hospitalizations in the U.S., leading to high resource use and significant health risks for patients.
  • The revised guidelines suggest using risk stratification tools to better identify patients who may not need invasive interventions, as well as recommendations on blood transfusions, reversal agents for anticoagulant use, and diagnostic approaches like colonoscopy and CTA.
  • The guidelines emphasize that most patients should have a nonurgent colonoscopy and outline updated protocols for resuming antiplatelet and anticoagulant medications post-LGIB management.

Article Abstract

Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.

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Source
http://dx.doi.org/10.14309/ajg.0000000000002130DOI Listing

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