Novel Oral Anticoagulants (NOACs) such as Dabigatran,
Rivaroxaban, Apixaban and Edoxaban are becoming increasingly popular choices for
anticoagulation in place of oral Vitamin K Antagonists in various clinical
settings. However, they are thought to be associated with an increased risk of
gastrointestinal bleeding. Moreover, no specific antidote is
available which can rapidly reverse the anti-coagulant action of NOACs raising
concern that gastrointestinal bleeding with NOACs could carry a worse prognosis
than that associated with conventional agents.
In this review, we describe a case of gastrointestinal bleeding in the
setting of NOAC use, followed by a brief overview of the pivotal trials
involving NOACs. Clinical issues such as pathophysiology, diagnosis and
management of NOAC induced GI bleeding have been described. Future trials will
help elucidate the true incidence, risk factors and preventive strategies for
NOAC associated gastrointestinal bleeding.
Credits: Amartya Kundu; Partha Sardar; Jessica Huston; Parijat Sen; Saurav Chatterjee; Ramez Nairooz; John J. Ryan; Wilbert S. Aronow