Novel anticoagulants: Bleeding risk and management strategies

Neena Susan Abraham, Diana L. Castillo

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose of Review: To quantify the novel oral anticoagulant (NOAC)-related gastrointestinal bleeding, summarize the management strategies and highlight the knowledge gaps. Recent Findings: Dabigatran, rivaroxaban and apixaban differ from warfarin with their fixed oral dose and no requirement for routine monitoring. Patients at highest risk of thromboembolism benefit most from NOACs; however, there is a clinically significant risk for NOAC-related gastrointestinal bleeding. The management of NOACs in the acute and elective setting differs from that used with warfarin. Summary: The magnitude of gastrointestinal risk is still unclear because of paucity of literature. Current risk-stratification models are incomplete and cannot be used solely to predict future risk. The periendoscopic management requires an understanding of drug half-life, metabolism and patient's ability to excrete the agent. Acute bleeding management relies on fluid resuscitation to promote renal excretion of active metabolite, withholding the doses and timely management of endoscopic stigmata. The administration of coagulation factors (fresh frozen plasma, prothrombin complex concentrates or recombinant activated FVII) is more successful in reversing the activity of the upstream inhibitors of coagulation (rivaroxaban and apixaban) than dabigatran which is a direct thrombin inhibitor.

Original languageEnglish (US)
Pages (from-to)676-683
Number of pages8
JournalCurrent Opinion in Gastroenterology
Volume29
Issue number6
DOIs
StatePublished - Nov 2013

Fingerprint

Risk Management
Anticoagulants
Hemorrhage
Warfarin
Christianity
Blood Coagulation Factors
Antithrombins
Thromboembolism
Resuscitation
Half-Life
Pharmaceutical Preparations
N(4)-oleylcytosine arabinoside
apixaban
Rivaroxaban
Dabigatran

Keywords

  • Acute gastrointestinal hemorrhage
  • apixaban
  • dabigatran
  • endoscopy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Novel anticoagulants : Bleeding risk and management strategies. / Abraham, Neena Susan; Castillo, Diana L.

In: Current Opinion in Gastroenterology, Vol. 29, No. 6, 11.2013, p. 676-683.

Research output: Contribution to journalArticle

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