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New generation of oral anticoagulants for gastrointestinal bleeding

A new generation of oral anticoagulants, which includes thrombin and factor Xa inhibitors, has been shown to be effective, for gastrointestinal bleeding, reports the latest issue of Gastroenterology.

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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 new generation of oral anticoagulants.

The team searched MEDLINE, EMbase, and the Cochrane library without language restrictions.

The researchers analyzed data from 43 randomized controlled trials that compared new generation of oral anticoagulants with standard care for risk of bleeding.

 

For thromboprophylaxis after orthopedic surgery the odds ratio was 0.8
Gastroenterology

The overall odds ratios for gastrointestinal bleeding among patients taking new generation of oral anticoagulants was 1.45 , but there was substantial heterogeneity among studies.

For thromboprophylaxis after orthopedic surgery the odds ratio was 0.8, for treatment of venous thrombosis the odds ratio was 1.6, and for acute coronary syndrome the odds ratio was 5.2.

Among the drugs studied, the odds ratio for apixaban was 1.2, the odds ratio for dabigatran was 1.6, the odds ratio for edoxaban was 0.3, and the odds ratios for rivaroxaban was 1.5.

The team found that the overall odds ratios for clinically relevant bleeding in patients was 1.16, with similar trends among subgroups.

The team comments, "Studies on treatment of venous thrombosis or acute coronary syndrome have shown that patients treated with oral anticoagulants therapy have an increased risk of gastrointestinal bleed, 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."

Gastroenterology 2013: 145(1): 105-112
16 July 2013

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