Abstract
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA.
Highlights
Since the Food and Drug Administration (FDA) approved new oral anticoagulants (NOACs) in 2010 [1,2], direct factor Xa inhibitors and direct thrombin inhibitors are available in clinical practice [3,4]
We included subjects who met the following three criteria: (1) patients who visited the hospital with symptoms of overt GI bleeding; (2) patients treated with anticoagulants for at least 3 months; (3) patients who underwent diagnostic esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, small bowel (SB) enteroscopy, or capsule endoscopy to identify the focus of GI bleeding, according to the diagnostic strategy of each hospital
Patients treated with New oral anticoagulants (NOACs) who experienced acute GI bleeding had different characteristics and clinical outcomes than those treated with vitamin K antagonists (VKA)
Summary
Since the Food and Drug Administration (FDA) approved new oral anticoagulants (NOACs) in 2010 [1,2], direct factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban) and direct thrombin inhibitors (dabigatran) are available in clinical practice [3,4]. 2016 European Society of Cardiology guidelines recommended NOACs for patients with non-valvular atrial fibrillation (NVAF) to prevent stroke [5]. Chest Physician guideline and expert panel report suggested a prescription in favor of NOACs to vitamin K antagonist (VKA) for the initial and long-term management of venous thromboembolism in patients without cancer [6]. In contrast to VKA, the NOACs directly inhibit a single clotting enzyme; dabigatran inhibits thrombin, whereas rivaroxaban, apixaban, and edoxaban inhibit factor Xa [7,8].
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