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Risk of gastrointestinal bleeding during anticoagulant treatment

Aitor Lanas-Gimeno1, Angel Lanas2,3,4

  • 1a Servicio de Aparato Digestivo , Hospital Universitario La Princesa , Madrid , Spain.

Expert Opinion on Drug Safety
|May 4, 2017
PubMed

Insights

Direct oral anticoagulants (DOACs) like dabigatran and rivaroxaban increase gastrointestinal bleeding (GIB) risk compared to warfarin. Apixaban shows no increased risk, while edoxaban

Area of Science:

  • Gastroenterology and Hematology
  • Pharmacology and Therapeutics

Background:

  • Gastrointestinal bleeding (GIB) is a significant complication for patients on oral anticoagulation therapy.
  • The introduction of direct oral anticoagulants (DOACs) has intensified concerns regarding GIB.
  • Understanding GIB risks associated with various anticoagulants is crucial for patient safety.

Purpose of the Study:

  • To review current evidence on GIB in patients using oral anticoagulants, including DOACs.
  • To analyze risk factors, bleeding locations, and prevention strategies for GIB.
  • To discuss the evolving clinical presentation of GIB in the context of anticoagulation therapy.

Main Methods:

  • Review of randomized controlled trials, meta-analyses, and post-marketing observational studies.
  • Synthesis of evidence on GIB risk associated with specific DOACs (dabigatran, rivaroxaban, edoxaban, apixaban) and warfarin.
  • Analysis of GIB risk factors, location, and prevention strategies.

Main Results:

  • Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily are associated with increased GIB risk compared to warfarin.
  • Edoxaban's GIB risk is dose-dependent; apixaban shows no apparent increased risk.
  • A shift towards lower GIB incidence is observed, potentially linked to DOACs in elderly populations with conditions like diverticular bleeding and angiodysplasia.

Conclusions:

  • The choice of oral anticoagulant impacts GIB risk, with varying profiles among DOACs.
  • Proton pump inhibitors and reduced H. pylori prevalence have decreased upper GIB, while lower GIB incidence has risen.
  • DOACs may contribute to the increased incidence of lower GIB, particularly in elderly patients.
Abstract

Keywords:
Apixabandabigatrandirect oral anticoagulationedoxabangastrointestinal bleedingrivaroxabanvitamin K antagonist (VKA)

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