High-dose dabigatran, rivaroxaban, and high-dose edoxaban are associated with a higher risk of gastrointestinal bleeding compared with warfarin.
Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b.i.d), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB.
Cheung et al. (Sun,) conducted a review in Patients on novel oral anticoagulants. Novel oral anticoagulants (NOACs) vs. Warfarin was evaluated on Gastrointestinal bleeding (GIB). High-dose dabigatran, rivaroxaban, and high-dose edoxaban are associated with a higher risk of gastrointestinal bleeding compared with warfarin.