[Direct oral anticoagulation and gastrointestinal bleeding: Interventional therapy management]

Area of Science:

• Cardiology
• Gastroenterology
• Pharmacology

Background:

• Direct oral anticoagulants (DOACs) are increasingly prescribed for anticoagulation.
• DOACs are associated with a higher incidence of gastrointestinal bleeding, particularly in the lower tract, compared to vitamin K antagonists.
• This necessitates a collaborative approach between gastroenterologists and cardiologists to manage bleeding risks.

Purpose of the Study:

• To elaborate on management strategies for gastrointestinal bleeding in patients treated with DOACs.
• To provide guidance for the joint efforts of gastroenterologists and cardiologists in addressing this clinical challenge.

Main Methods:

• A selective literature search was conducted.
• Clinical experiences were incorporated into the analysis.

Main Results:

• Management decisions for procoagulant therapy (e.g., prothrombin complex concentrate) require critical assessment of various factors.
• Identifying and excluding reversible bleeding triggers, such as drug interactions and renal impairment, is crucial post-bleeding.
• Balancing the risk of recurrent bleeding against thromboembolic events is essential when readministering anticoagulants.
• Options for risk reduction include dose modification, switching to apixaban, or considering vitamin K antagonists.

Conclusions:

• The precise role of specific antidotes in managing DOAC-related bleeding remains to be determined.
• Further research is needed to clarify the optimal use of specific antidotes.