Gastrointestinal bleeding with the new oral anticoagulants – defining the issues and the management strategies

Desai, Jaydev P.; Kolb, Jennifer M.; Weitz, Jeffrey I.; Aisenberg, James

doi:10.1160/th13-02-0150

Cited by 169 publications

(162 citation statements)

References 41 publications

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“…Вследствие широкого использования этих ле-карств связанные с ними осложнения стали важной меди-цинской и социальной проблемой [5][6][7]. Серьезность дан-ной проблемы показывает работа американских ученых, посвященная частоте летальных исходов, связанных с приемом НОАК.…”

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“…Как оказалось, НОАК, хотя имеют иной механизм действия, чем НДА и варфарин, вызывают желудочно-кишечные кровотечения столь же часто, как «старые» антитромботические средства [6,7].…”

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“…Локальное по-вреждение богатой сосудами ткани неизбежно вызывает минимальное кровоизлияние в СО. Однако НОАК вслед-ствие как системного, так и местного действия блокируют свертывание крови и образование тромба, а также могут спровоцировать продолжение кровотечения [6,7].…”

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“…При этом да-бигатрана этексилат (пролекарство) подвергается био-трансформации под воздействием кишечных эстераз с высвобождением активного дабигатрана. Это создает предпосылки для контактного повреждающего действия на СО ЖКТ, в том числе кишечника [6,7]. Важно отме-тить, что для дабигатрана описано развитие поражения пищевода (см.…”

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“…Кроме того, обсуждается биологическое действие НОАК, не связанное с антитромботическим эф-фектом. Вероятно, они могут вызывать изменения состо-яния слизи, покрывающей СО и защищающей ее от дей-ствия внешних факторов агрессии, или замедлять зажив-ление уже имеющихся повреждений СО [6,7,18].…”

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Gastrointestinal Bleeding With the Use of New Oral Anticoagulants: Epidemiology, Risk Factors, Treatment, and Prevention

Мороз¹,

Каратеев²,

Крюков³

et al. 2017

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Gastrointestinal Bleeding With the Use of New Oral Anticoagulants: Epidemiology, Risk Factors, Treatment, and Prevention

Мороз¹,

Каратеев²,

Крюков³

et al. 2017

rsp

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Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Kikuchi,

Kono,

Nakagawa

et al. 2023

JGH Open

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Background and AimAnticoagulant users with nonvalvular atrial fibrillation (NVAF) sometimes suffer from gastrointestinal bleeding (GIB) and have difficulty continuing the medication. Left atrial appendage closure (LAAC) has been developed for such situations. We aimed to clarify the clinical significance of a history of GIB in comparison to other factors in patients who had undergone LAAC.MethodsFrom October 2019 to September 2023, patients with NVAF who underwent LAAC at our hospital were enrolled. We investigated the percentage of patients with a history of GIB who underwent LAAC and compared the incidence of post‐LAAC bleeding in these patients compared to those with other factors.ResultsA total of 45 patients were included. There were 19 patients (42%) with a history of GIB who underwent LAAC. In a Kaplan–Meier analysis, the cumulative incidence of bleeding complications after LAAC was significantly higher in patients with a history of GIB in comparison to patients with other factors. There were eight cases of post‐LAAC bleeding in total, and seven cases had GIB.ConclusionsWe need to recognize that GIB is a significant complication in patients who undergo LAAC. The management of GIB by gastroenterologists is essential to the success of LAAC.

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Relevance of physicochemical properties and functional pharmacology data to predict the clinical safety profile of direct oral anticoagulants

Ferro

Solkhon

Jalal

et al. 2020

Pharmacology Res & Perspec

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Direct oral anticoagulants (DOACs) have rapidly become the drug class of choice for anticoagulation therapy in secondary care. It is known that gastrointestinal hemorrhage are potential side effects of the DOAC drug class. In this study we have investigated the relevance of molecular structure and on/off‐target pharmacology as a predictor of adverse drug reactions (ADRs) for the DOAC drug class. Use of the Reaxys MedChem module allowed for data mining of all possible reported off‐target effects of the DOAC class members. For the first time, the MHRA Yellow card database in combination with prescribing rates in the United Kingdom (data for n = 30 566 936 DOAC Rx (up to 2017) and ADR data n = 22 275 (up to 2018)) were used for our data comparison of DOACs. From the underlying reported data, we were able to rank the DOACs in terms of the likely adverse events we would expect to observe. We identified potential risks of ADRs based on the DOACs pharmacology including the expected GI hemorrhage, but also the unexpected risk of stroke, pulmonary embolism and kidney injury. Statistically significant (P < .001) differences were found between all DOACs and their total number of ADRs. Although the risks are small, strong statistical correlation between observed pharmacology and national ADR data is observed in three out of the five areas of concern.

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Gastrointestinal bleeding with the new oral anticoagulants – defining the issues and the management strategies

Cited by 169 publications

References 41 publications

Gastrointestinal Bleeding With the Use of New Oral Anticoagulants: Epidemiology, Risk Factors, Treatment, and Prevention

Gastrointestinal Bleeding With the Use of New Oral Anticoagulants: Epidemiology, Risk Factors, Treatment, and Prevention

Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Relevance of physicochemical properties and functional pharmacology data to predict the clinical safety profile of direct oral anticoagulants

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