Gastrointestinal (GI) bleeding is a common adverse event associated with conventional
anticoagulants, such as vitamin K antagonist (VKA) (e.g. warfarin) [
[1]
]. Most such bleeding events are reported to occur within the first year of therapy.
Based on clinical trials results, the incidence of GI bleeding is reported to be higher
with the direct oral anticoagulants (DOACs), in particular with Rivaroxaban and Dabigatran,
when compared with warfarin. As with warfarin-related GI bleeding, DOACs-related GI
bleeding could reflect an underlying structural pathology until proven otherwise,
and warrants careful and complete investigation [
[2]
]. The higher incidence of GI bleeding with some DOACs may be related to pre-existing
gastrointestinal lesions. In this way, GI bleeding could be a surrogate of GI lesions
(e.g. neoplasia). DOACs-related GI bleeding may represent the unmasking of pre-existing
malignancies, leading to increased detection of GI cancer, in particular at an early
stage. This may be especially in the first period of treatment, and could explain
the potential role of DOACs in “anticoagulation GI stress-test” triggers [
[3]
].Keywords
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References
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- Gastrointestinal bleeding in the setting of anticoagulation and antiplatelet therapy.J Clin Gastroenterol. 2009; 43: 5-12
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Article info
Publication history
Published online: February 24, 2017
Accepted:
February 20,
2017
Received in revised form:
February 14,
2017
Received:
February 7,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
