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Am Fam Physician. 2023;107(5):552-553

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Platelet transfusions appear to increase mortality in patients with GI bleeding who are taking antiplatelet agents.

• Patients should continue taking aspirin for secondary cardiovascular protection in GI bleeding because stopping aspirin does not improve bleeding outcomes and may increase mortality.

• Prothrombin complex concentrates do not appear beneficial for GI bleeding related to direct oral anticoagulants but may be beneficial for patients taking warfarin. 

From the AFP Editors

The major risk of taking antithrombotic medications, including antiplatelet and anticoagulation agents, is gastrointestinal (GI) bleeding. The optimal means of managing bleeding episodes is uncertain. The American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology conducted a systematic review to publish guidelines for managing GI bleeding for patients who are taking antithrombotic medications.

Antiplatelet Medications

When patients who take antiplatelet medications have GI bleeding, platelet transfusions may be harmful. In a small cohort study, patients receiving platelet transfusions had an increased risk of death over patients who did not receive platelet transfusions, with no difference in further bleeding or thrombotic events.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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