Incidence and Clinical Presentation of Gastrointestinal Bleeding in Atrial Fibrillation Patients Taking Direct Oral Anticoagulants

摘要

Gastrointestinal (Gl) bleeding is an important concern in patients treated with direct oral anticoagulants (DOACs). Pre-market and post-market studies permit nuanced evaluation of the clinical details associated with Gl bleeding events. In this comprehensive analysis, we review the relevant pre-market clinical trial data and 15 post-market retrospective and prospective studies related to Gl bleeding in DOAC users. Although individual DOACs differ, consistent themes emerge and are emphasized. Observations noted in the post-market literature are generally consistent with the findings of the randomized controlled trials. Reassuringly, over 90% of Gl bleeding events in DOAC users are not life-threatening. Risk factors such as advanced age and concomitant antiplatelet or nonsteroidal anti-inflammatory drug use are associated with a higher incidence of Gl bleeding in DOAC users, and particular attention to bleeding prevention strategies is required in these settings. Here we summarize evidence regarding the clinical characteristics of Gl bleeding in DOAC users, including timing, source, and outcome of these events. These findings enable physicians to maximize the net clinical benefit of anticoagulation therapy in atrial fibrillation patients, and to maintain a focus on preventing irreversible harm secondary to stroke or systemic emboli.