Anticoagulation-related bleeding is by far the most common complication caused by these compounds. It is also potentially life-threatening. The patient’s comorbidities and comedication impact heavily on individual risk. A history of gastrointestinal bleeding due to ulceration predisposes to recurrent bleeding. Risk of bleeding can be estimated using established scoring systems.
Continuous i.v. heparin infusion is superior to i.v. bolus application in terms of bleeding complication rates, whereas low-molecular-weight-heparins are as effective and even more advantageous in terms of such complications.
Typically, endoscopy reveals the usual pathologies with no identifiable bleeding source.
In order to avoid such a complication, indications for anticoagulation therapy should be carefully selected, the lowest possible level of anticoagulation chosen and, whenever possible, self-monitoring should be recommended. A routine gastroscopy before starting anticoagulant therapy is not indicated.