The Impact of Novel Anticoagulants on the Upper Gastrointestinal Tract Mucosa

Abstract

Background and objectives: Although treatment with novel oral non-vitamin K antagonist 3anticoagulants (NOACs) is associated with an overall decrease in hemorrhagic complications compared to warfarin, the incidence of gastrointestinal bleeding remains contradictory. Materials and Methods: After the exclusion of patients with pre-existing pathological lesions in the upper gastrointestinal tract (GIT) on esophageal-gastroduodenoscopy (EGD) at entry, a cohort of 80 patients (mean age of 74.8 ± 2.0 years) was randomly divided into four equivalent groups, treated with dabigatran, rivaroxaban, apixaban, or warfarin. Patients were prospectively followed up for three months of treatment, with a focus on anamnestic and endoscopic signs of bleeding. In addition, bleeding risk factors were evaluated. Results: In none of the patients treated with warfarin or NOACs was any serious or clinically significant bleeding recorded within the follow-up period. The incidence of clinical bleeding and endoscopically detected bleeding in the upper GT after three months of treatment was not statistically different among groups (χ2 = 2.8458; p = 0.41608). The presence of Helicobacter pylori (HP) was a risk factor for upper GIT bleeding (p < 0.05), while the use of proton pump inhibitors (PPIs) was a protective factor (p = 0.206; Spearman’s correlation coefficient = 0.205). We did not record any post-biopsy continued bleeding. Conclusions: No significant GIT bleeding was found in any of the treatment groups, so we consider it beneficial to perform routine EGD before the initiation of any anticoagulant therapy in patients with an increased risk of upper GIT bleeding. Detection and eradication of HP as well as preventive PPI treatment may mitigate the occurrence of endoscopic bleeding. Endoscopic biopsy during the NOAC treatment is safe.

Analysis of Adverse Events in the Treatment of Patients with Non-Valvular Atrial Fibrillation with Oral Anticoagulants: Data from the “ANTEY” Observational Study

“…However, according to the results of the Ko YJ study, based on the Korea Institute of Drug Safety and Risk Management–Korea database, it was found that rivaroxaban was associated with the more frequent development of bleeding events than treatment with dabigatran or apixaban [ 21 ]. The results of our study and data from a number of other studies did not identify any significant differences between the different NOACs in the incidence of bleeding [ 22 , 23 ].…”

Anticoagulant therapy for the prevention of recurrent stroke in patients with atrial fibrillation: a comprehensive risk management

“…Особый интерес представляет публикация результатов наблюдения влияния 3-х ПОАК на слизистую желудочно-кишечного тракта, которое показало, что через 3 мес. терапии нет достоверных различий в частоте клинически и эндоскопически значимых кровотечений из желудочно-кишечного тракта ни на одном из ПОАК в сравнении с варфарином, а основной причиной кровотечений авторы называют присутствие Helicobacter pylori [34]. Эти данные указывают на первостепенное значение обследования пациентов до начала длительной антикоагулянтной терапии.…”

Potential for anticoagulant therapy in the most vulnerable groups of patients

“…Соответственно, чем более коморбиден пациент, тем выше риск кровотечений независимо от принимаемого антикоагулянта, а значит важно искать причину и модифицировать ее, вместо поиска "самого безопасного" антикоагулянта [40,41].…”