Key result
DOAC adjustment, prophylactic PPIs, and H. pylori eradication reduce gastrointestinal bleeding risk in high-risk patients.
Why the study?
Despite the high efficacy and safety of direct oral anticoagulants, therapy is accompanied by an increased risk of hemorrhage, including gastrointestinal bleeding.
Does the management of modifiable risk factors and use of prophylactic gastroprotective agents reduce the risk of gastrointestinal bleeding in patients receiving DOAC therapy?
Does the management of modifiable risk factors and use of prophylactic gastroprotective agents reduce the risk of gastrointestinal bleeding in patients receiving DOAC therapy?
Proactive management of modifiable risk factors and the use of prophylactic gastroprotective agents are essential to minimize the risk of gastrointestinal bleeding in patients on DOAC therapy.
Answers are grounded in this paper and cite their sources.
Supports modifiable risk factor management in DOAC patients; leaves open randomized confirmation of bleeding reduction.
Direct oral anticoagulants (DOACs) are used to prevent and treat thrombosis and thromboembolic events in patients with various diseases. Despite its high efficacy and safety, DOAC therapy is accompanied by increased risk of hemorrhage, including gastrointestinal bleeding. Bleeding risk depends on individual patient profile and their risk factors. An increased risk of bleeding is associated with manifesting effect of DOACs on existing mucosal defects, active Helicobacter pylori infection. To reduce the risk of gastrointestinal bleeding in clinical practice, changing of following modifiable risk factors is required: H. pylori eradication; dose-adjusted DOAC therapy; prophylactic proton pump inhibitors (PPIs) administration to patients with HAS-BLED score ≥3, receiving dual or triple antithrombotic therapy, taking DOACs in combination with non-steroidal antiinflammatory drugs, to those with upper gastrointestinal diseases. In addition to PPIs, patients may be prescribed with rebamipide, bismuth tripotassium dicitrate, ursodeoxycholic acid. DOAC rivaroxaban (Xarelto®) has pharmacokinetic and pharmacodynamic advantages, a convenient single dosing regimen and a favorable safety profile, which provides effective protection against thrombosis and thromboembolic events in combination with low risk of gastrointestinal bleeding.
No takes yet. Share an insight, caveat, or question.
Бакулина et al. (2021) conducted a review in Gastrointestinal bleeding in patients receiving anticoagulant therapy. Management of modifiable risk factors (H. pylori eradication, dose-adjusted DOACs, prophylactic PPIs) was evaluated. Management of modifiable risk factors, including H. pylori eradication, dose-adjusted DOAC therapy, and prophylactic PPIs in high-risk patients, is required to reduce gastrointestinal bleeding risk.
Synapse has enriched 10 related papers. Consider them for comparative context: