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2017 ; 23
(11
): 1954-1963
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gab.com Text
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Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk,
prevention and management
#MMPMID28373761
Cheung KS
; Leung WK
World J Gastroenterol
2017[Mar]; 23
(11
): 1954-1963
PMID28373761
show ga
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 specific reversal agents such as idarucizumab for dabigatran and
andexanent alfa for factor Xa inhibitors, and urgent endoscopic management.
|Administration, Oral
[MESH]
|Anticoagulants/administration & dosage/*adverse effects/therapeutic use
[MESH]