Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Gastrointestinal bleeding

Gastrointestinal bleeding risk is increased by novel anticoagulants

A report has demonstrated that in patients with atrial fibrillation the novel oral anticoagulant, dabigatran, increases the risk of gastrointestinal bleeding by nearly twofold compared with warfarin. Here, the risk of gastrointestinal bleeding associated with anticoagulants and antiplatelet agents is placed into clinical context and key management principles are emphasized.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Harper, P., Young, L. & Merriman, E. Bleeding risk with dabigatran in the frail elderly. N. Engl. J. Med. 366, 864–866 (2012).

    Article  CAS  PubMed  Google Scholar 

  2. Southworth, M. R., Reichman, M. E. & Unger, E. F. Dabigatran and postmarketing reports of bleeding. N. Engl. J. Med. 368, 1272–1274 (2013).

    Article  CAS  PubMed  Google Scholar 

  3. Larsen, T. B. et al. Efficacy and safety of dabigatran etexilate and warfarin in “real-world” patients with atrial fibrillation: a prospective nationwide cohort study. J. Am. Coll. Cardiol. 61, 2264–2273 (2013).

    Article  CAS  PubMed  Google Scholar 

  4. Sipahi, I., Celik, S. & Tozun, N. A comparison of results of the US food and drug administration's mini-sentinel program with randomized clinical trials: the case of gastrointestinal tract bleeding with dabigatran. JAMA Intern. Med. 174, 150–151 (2014).

    Article  PubMed  Google Scholar 

  5. Holster, I. L., Valkhoff, V. E., Kuipers, E. J. & Tjwa, E. T. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145, 105–112 (2013).

    Article  CAS  PubMed  Google Scholar 

  6. Hernandez, I., Baik, S. H., Piñera, A. & Zhang, Y. Risk of bleeding with dabigatran in atrial fibrillation. JAMA Intern. Med. http://dx.doi.org/10.1001/jamainternmed.2014.5398.

  7. Komócsi, A., Vorobcsuk, A., Kehl, D. & Aradi, D. Use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an acute coronary syndrome: systematic review and meta-analysis of randomized controlled trials. Arch. Intern. Med. 172, 1537–1545 (2012).

    Article  PubMed  Google Scholar 

  8. Abraham, N. S. et al. Risk of lower and upper gastrointestinal bleeding, transfusions, and hospitalizations with complex antithrombotic therapy in elderly patients. Circulation 128, 1869–1877 (2013).

    Article  CAS  PubMed  Google Scholar 

  9. Lamberts, M. et al. Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy: a nationwide cohort study. Ann. Intern. Med. 161, 690–698 (2014).

    Article  PubMed  Google Scholar 

  10. Greenberg, P. D., Cello, J. P. & Rockey, D. C. Asymptomatic chronic gastrointestinal blood loss in patients taking aspirin or warfarin for cardiovascular disease. Am. J. Med. 100, 598–604 (1996).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Don C. Rockey.

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rockey, D. Gastrointestinal bleeding risk is increased by novel anticoagulants. Nat Rev Gastroenterol Hepatol 12, 131–132 (2015). https://doi.org/10.1038/nrgastro.2015.7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrgastro.2015.7

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing