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Article: Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management

TitleGastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management
Authors
Issue Date2017
PublisherBaishideng Publishing Group. The Journal's web site is located at http://www.wjgnet.com/1007-9327/index.htm
Citation
World Journal of Gastroenterology, 2017, v. 23, p. 1954-1963 How to Cite?
AbstractNovel 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.
Persistent Identifierhttp://hdl.handle.net/10722/243772
ISSN
2017 Impact Factor: 3.3
2015 SCImago Journal Rankings: 1.076
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, KS-
dc.contributor.authorLeung, WK-
dc.date.accessioned2017-08-25T02:59:19Z-
dc.date.available2017-08-25T02:59:19Z-
dc.date.issued2017-
dc.identifier.citationWorld Journal of Gastroenterology, 2017, v. 23, p. 1954-1963-
dc.identifier.issn1007-9327-
dc.identifier.urihttp://hdl.handle.net/10722/243772-
dc.description.abstractNovel 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.-
dc.languageeng-
dc.publisherBaishideng Publishing Group. The Journal's web site is located at http://www.wjgnet.com/1007-9327/index.htm-
dc.relation.ispartofWorld Journal of Gastroenterology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleGastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management-
dc.typeArticle-
dc.identifier.emailLeung, WK: hku75407@hku.hk-
dc.identifier.authorityLeung, WK=rp01479-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3748/wjg.v23.i11.1954-
dc.identifier.hkuros273712-
dc.identifier.volume23-
dc.identifier.spage1954-
dc.identifier.epage1963-
dc.identifier.isiWOS:000397612200004-
dc.publisher.placeUnited States-

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