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Gastrointestinal bleeding

Gastrointestinal bleeding risk is increased by novel anticoagulants

A report has demonstrated that in patients with atrial fibrillation the novel oral anticoagulant, dabigatran, increases the risk of gastrointestinal bleeding by nearly twofold compared with warfarin. Here, the risk of gastrointestinal bleeding associated with anticoagulants and antiplatelet agents is placed into clinical context and key management principles are emphasized.

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  1. Harper, P., Young, L. & Merriman, E. Bleeding risk with dabigatran in the frail elderly. N. Engl. J. Med. 366, 864–866 (2012).

    CAS  Article  PubMed  Google Scholar 

  2. Southworth, M. R., Reichman, M. E. & Unger, E. F. Dabigatran and postmarketing reports of bleeding. N. Engl. J. Med. 368, 1272–1274 (2013).

    CAS  Article  PubMed  Google Scholar 

  3. Larsen, T. B. et al. Efficacy and safety of dabigatran etexilate and warfarin in “real-world” patients with atrial fibrillation: a prospective nationwide cohort study. J. Am. Coll. Cardiol. 61, 2264–2273 (2013).

    CAS  Article  PubMed  Google Scholar 

  4. Sipahi, I., Celik, S. & Tozun, N. A comparison of results of the US food and drug administration's mini-sentinel program with randomized clinical trials: the case of gastrointestinal tract bleeding with dabigatran. JAMA Intern. Med. 174, 150–151 (2014).

    Article  PubMed  Google Scholar 

  5. Holster, I. L., Valkhoff, V. E., Kuipers, E. J. & Tjwa, E. T. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145, 105–112 (2013).

    CAS  Article  PubMed  Google Scholar 

  6. Hernandez, I., Baik, S. H., Piñera, A. & Zhang, Y. Risk of bleeding with dabigatran in atrial fibrillation. JAMA Intern. Med.

  7. Komócsi, A., Vorobcsuk, A., Kehl, D. & Aradi, D. Use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an acute coronary syndrome: systematic review and meta-analysis of randomized controlled trials. Arch. Intern. Med. 172, 1537–1545 (2012).

    Article  PubMed  Google Scholar 

  8. Abraham, N. S. et al. Risk of lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic therapy in elderly patients. Circulation 128, 1869–1877 (2013).

    CAS  Article  PubMed  Google Scholar 

  9. Lamberts, M. et al. Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy: a nationwide cohort study. Ann. Intern. Med. 161, 690–698 (2014).

    Article  PubMed  Google Scholar 

  10. Greenberg, P. D., Cello, J. P. & Rockey, D. C. Asymptomatic chronic gastrointestinal blood loss in patients taking aspirin or warfarin for cardiovascular disease. Am. J. Med. 100, 598–604 (1996).

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Don C. Rockey.

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Rockey, D. Gastrointestinal bleeding risk is increased by novel anticoagulants. Nat Rev Gastroenterol Hepatol 12, 131–132 (2015).

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