A new generation of oral anticoagulants, which includes thrombin and factor Xa inhibitors, has been shown to be effective, but little is known about whether these drugs increase patients’ risk for gastrointestinal (GI) bleeding.
Patients who require oral anticoagulants therapy frequently have significant comorbidities and may also take aspirin and/or thienopyridines.
Dr Lisanne Holster and colleagues from The Netherlands performed a systematic review and meta-analysis of the risk of gastrointestinal bleeding and clinically relevant bleeding in patients taking anticoagulants.
The team searched MEDLINE, EMbase, and the Cochrane library without language restrictions.
The research team analyzed data from 43 randomized controlled trials that compared anticoagulants with standard care for risk of bleeding.
Odds ratios were estimated using a random-effects model.
|The overall odds ratios for GI bleeding among patients taking anticoagulants was 1.45|
The doctors examined that the overall odds ratios for gastrointestinal bleeding among patients taking anticoagulants was 1.45, but there was substantial heterogeneity among studies.
Subgroup analyses showed that the odds ratios for atrial fibrillation was 1.21, for thromboprophylaxis after orthopedic surgery the odds ratio was 0.78, for treatment of venous thrombosis the odds ratio was 1.59, and for acute coronary syndrome the odds ratio was 5.21.
The researchers assessed that among the drugs studied, the odds ratios for apixaban was 1.23, the odds ratio for dabigatran was 1.58, the odds ratio for edoxaban was 0.31, and the Odds ratios for rivaroxaban was 1.48.
The overall odds ratios for clinically relevant bleeding in patients taking anticoagulants was 1.16, with similar trends among subgroups.
Dr Holster's team concluded, "Studies on treatment of venous thrombosis or acute coronary syndrome have shown that patients treated with anticoagulants have an increased risk of gastrointestinal bleeding, compared with those who receive standard care."
"Better reporting of gastrointestinal bleeding events in future trials could allow stratification of patients for therapy with gastroprotective agents."