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Gastrointestinal Bleeding and Direct Oral Anticoagulants among Patients with Atrial Fibrillation: Risk, Prevention,

Paolo Zappulla1, Valeria Calvi1

  • 1Division of Cardiology, Centro alte specialità e trapianti (C.A.S.T.), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco," University of Catania, Catania, Italy.

TH Open : Companion Journal to Thrombosis and Haemostasis
|June 21, 2021
PubMed

Insights

Direct oral anticoagulants (DOACs) increase gastrointestinal bleeding (GIB) risk, with rivaroxaban, dabigatran, and edoxaban showing higher risks. Apixaban did not increase GIB risk compared to warfarin.

Area of Science:

  • Pharmacology
  • Gastroenterology
  • Clinical Medicine

Background:

  • Gastrointestinal bleeding (GIB) is a significant complication for patients on oral anticoagulation therapy.
  • The introduction of direct oral anticoagulants (DOACs) has heightened concerns regarding GIB.
  • Patient quality of life (QOL) is impacted by long-term anticoagulation, necessitating lifestyle changes and increasing bleeding risk without clear symptomatic benefit.

Purpose of the Study:

  • To examine current evidence on GIB associated with oral anticoagulants, focusing on DOACs.
  • To compare the GIB risk profiles of different DOACs and warfarin.
  • To summarize GIB risk factors, prevention strategies, and management of DOAC therapy post-GIB.

Main Methods:

  • Review of randomized controlled trials.
  • Analysis of meta-analyses.
  • Evaluation of postmarketing observational studies.

Main Results:

  • Rivaroxaban and dabigatran (150-mg dose) were associated with an increased risk of GIB.
  • Edoxaban use also showed a dose-dependent increase in GIB risk.
  • Apixaban demonstrated no higher GIB risk compared to warfarin.

Conclusions:

  • Different DOACs exhibit varying GIB risk profiles.
  • Understanding individual anticoagulant risks is crucial for patient safety.
  • Strategies for GIB prevention and post-episode management are essential for optimizing anticoagulation therapy.

Keywords:
apixabandabigatranedoxabangastrointestinal bleedingoral anticoagulantrivaroxabanwarfarin

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