Commentary: Controversies in SIGN guidance on management of acute upper and lower gastrointestinal blood loss

doi:10.1136/bmj.a1836

Published 10 October 2008, doi:10.1136/bmj.a1836
Cite this as: BMJ 2008;337:a1836

Practice

Commentary: Controversies in SIGN guidance on management of acute upper and lower gastrointestinal blood loss

Martin Keuchel, consultant, Friedrich Hagenmüller, professor of medicine

¹ Asklepios Klinik Altona, Paul-Ehrlich-Strasse 1, 22763 Hamburg, Germany

m.keuchel@asklepios.com

Practice, doi:10.1136/bmj.a1832

The first 150 words of the full text of this article appear below.

The SIGN guidelines present the evidence on management of acutegastrointestinal bleeding comprehensively, with concrete recommendationsfor diagnosis and treatment of varical and non-varical uppergastrointestinal bleeding. For patients with peptic ulcer bleedingwho are taking aspirin, the guidance advises discontinuationof aspirin or consideration of alternative drugs. A matter ofconcern in recent years is the combined use of aspirin and clopidogrelin patients with acute coronary syndrome or drug eluting coronarystents, which improves cardiovascular morbidity but at increasedrisk of bleeding.¹ The discontinuation of thrombocyte aggregationinhibitors as advised by the SIGN guidelines may improve haemostasisand reduce the risk of aggravating ongoing bleeding or inducingrebleeding during endoscopic treatments.

On the other hand, stent thrombosis may be an even more lifethreatening risk than gastrointestinal haemorrhage, which canbe treated by blood transfusion. Individual treatment plans,involving both cardiologist and gastroenterologist, are necessaryfor patients with . . . [Full text of this article]

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Management of acute gastrointestinal blood loss: summary of SIGN guidelines: K Palmer, M Nairn on behalf of the Guideline Development Group
BMJ 2008 337: a1832. [Extract] [Full Text]