Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management.

Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management.
World J Gastroenterol. 2017 Mar 21;23(11):1954-1963
Authors: Cheung KS, Leung WK
Abstract
Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b.i.d), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB. Prevention of NOAC-related GIB includes proper patient selection, using a lower dose of certain NOACs and in patients with renal impairment, correction of modifiable risk factors, and prescription of gastroprotective agents. Overt GIB can be managed by withholding NOACs followed by delayed endoscopic treatment. In severe bleeding, additional measures include administration of activated charcoal, use of...

Source: World Journal of Gastroenterology : WJG - March 21, 2017 Category: Gastroenterology Authors: Cheung KS, Leung WK Tags: World J Gastroenterol Source Type: research