Novel oral anticoagulants and gastrointestinal issues – is there a reason for concern?

Abstract:

New oral anticoagulants (NOAC) are effective and safe medicines. Dabigatran has a specific mechanism of activation in the GI tract and thereby a higher concentration of drug in the mucosa. Patients on dabigatran have more dyspepsia than those on other NOACs, which can be effectively solved by taking the drug with water, food or the introduction of IPP. Rivaroxaban has the highest rate of GI bleeding and apixaban the lowest. Dabigatran is the only NOAC with two doses tested separately, where the risk factors for GI bleeding were taken into account in a pivotal study. A lower dose of dabigatran demonstrated equal efficacy compared to warfarin with significantly less major bleedings and equal GI bleedings, whereas the higher doses showed greater efficacy vs. warfarin with equal large bleedings and more GI bleedings. The NOAC data from the world registries has demonstrated their favorable safety profile with no significant difference in the rate of bleeding between dabigaran and apixaban, with higher rate in rivaroxaban. In the case of otherwise rare GI bleeding in patients on NOAC, efficient endoscopic methods of hemostasis are available, and for those on dabigatran there is also an additional safety measure, a specific antidote idarucizumab.

Key words:
GI bleeding; Hemospray; idarucizumab; NOAC; warfarin