Management of Baclofen in Patients with Gastrointestinal Bleeding

Assessment of GI Bleeding Severity

For patients with active GI bleeding, initial management should focus on hemodynamic stabilization and assessment of bleeding severity 2, 3
Withhold oral anticoagulants immediately upon presentation with GI bleeding and correct coagulopathy according to the severity of hemorrhage 1
For unstable GI hemorrhage with hemodynamic compromise, consider reversal of anticoagulation with prothrombin complex concentrate and vitamin K if the patient is on warfarin 4, 5

If the patient is also on antiplatelet therapy for secondary prevention, this should not be routinely stopped 2, 6
For patients on dual antiplatelet therapy with coronary stents, management should be coordinated with a cardiologist 2, 6
If the patient is on anticoagulation therapy, interrupt warfarin therapy at presentation with GI bleeding 2, 4
For patients with high thrombotic risk, consider low molecular weight heparin treatment at 48 hours after hemostasis 2, 3
For patients with low thrombotic risk, restart warfarin at 7 days after bleeding has stopped 4, 1

Consider proton pump inhibitor therapy to reduce risk of recurrent GI bleeding, especially if the patient requires concomitant antiplatelet therapy 7, 6

Unnecessarily prolonged discontinuation of antiplatelet therapy for secondary prevention increases thrombotic risk and mortality 6