Coagulopathy as a risk factor of venous thromboembolism in patients with acute nonvariceal gastrointestinal bleeding
DOI:
https://doi.org/10.11603/2414-4533.2017.3.7939Keywords:
acute nonvariceal gastrointestinal bleeding, coagulopathy, venous thromboembolism.Abstract
The aim of the works: risk evaluation of venous thromboembolism in patients with acute nonvariceal gastrointestinal bleeding.
Materials and Methods. Treatment results of 246 with acute nonvariceal gastrointestinal bleeding was carried out. Gastroduodenoscopy had been performed aiming to recognize source of bleeding and risk of rebleeding in accordance with J. Forrest classification as well. Duodenal peptic ulcer disease was recognized as main source of bleeding in 83.7 % of patients. Endoscopic haemostasis had performed in patients with ongoing bleeding and high risk of its recurrence: Forrest 1А (2.5 %), Forrest 1В (12.8 %) and Forrest 2А (10.3 %), Forrest 2В (19.4 %), respectively. Ten patients died (mortality – 4.1 %) but no one from ongoing bleeding. Acute cardiopulmonary insufficiency as the main cause of death was recognized. Proximal deep vein thrombosis was revealed in 2 patients and in 4 cases – pulmonary thromboembolism. Coagulation status was evaluated in accordance with local protocol.
Results and Discussion. In 70.3 % of patients coagulation tests were in the normal limits, whereas hypercoagulation and hypocoagulation were recognized in 25.3 % and 4.4 % of cases, respectively. Hypercoagulation was recognized when shortening of clotting time, prothrombin time and elevated concentration of D-dimers were revealed. High risk of VTE according with Caprini score was calculated. Main VTE – risk factors were recognized: prolonged bed rest – more than 72 hours, age 61–74 years, previous VTE, central vein catheterization.
Conclusions. Hypercoagulation in patients with acute nonvariceal gastrointestinal bleeding combined with other factors constitutes
high risk of VTE.
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