What gastroenterologists should know about direct oral anticoagulants

Area of Science:

• Gastroenterology
• Pharmacology
• Cardiology

Background:

• Direct oral anticoagulants (DOACs) are increasingly prescribed for non-valvular atrial fibrillation and venous thromboembolism.
• DOACs offer advantages over vitamin K antagonists, including predictable effects and fewer interactions, but gastrointestinal (GI) bleeding remains a significant concern.
• Current management of DOAC-related GI bleeding and periendoscopic care lacks standardized approaches due to limited clinical data.

Purpose of the Study:

• To comprehensively review the risk of GI bleeding associated with DOAC therapy.
• To identify patient-specific risk factors for individualizing DOAC treatment and management.
• To outline strategies for managing DOACs during bleeding events and for elective procedures.

Main Methods:

• Systematic literature review of DOACs, GI bleeding, and periendoscopic management.
• Analysis of risk factors contributing to DOAC-related GI bleeding.
• Development of management algorithms for bleeding complications and procedural care.

Main Results:

• The study provides a detailed assessment of GI bleeding risks linked to DOACs.
• It highlights key patient factors influencing bleeding risk, enabling personalized treatment.
• Proposed algorithms offer guidance for managing bleeding and periendoscopic care.

Conclusions:

• Standardized clinical approaches are needed for managing DOAC-related GI bleeding and periendoscopic care.
• Individualized risk assessment and evidence-based management strategies are crucial.
• Further research and guideline development are necessary to optimize patient safety.