Impact of new oral anticoagulants on gastrointestinal bleeding in atrial fibrillation: A meta-analysis of interventional trials

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
Lorenzo LoffredoFrancesco Violi

Abstract

New oral anticoagulants represent an alternative to standard therapy with vitamin K antagonists but data regarding gastrointestinal bleeding are still unclear. To investigate if new oral anticoagulants are associated with an enhanced risk of gastrointestinal bleeding vs warfarin in patients with atrial fibrillation. Meta-analysis of phase three randomized controlled trials to compare the incidence of gastrointestinal bleeding in atrial fibrillation patients treated with new oral anticoagulants (apixaban, dabigatran, edoxaban and rivaroxaban) vs warfarin. Four studies including 71,302 patients were selected. Compared with warfarin, new oral anticoagulants significantly increased gastrointestinal bleeding (RR: 1.23; 95% CI 1.03-1.46; p=0.01). Rivaroxaban (RR: 1.46; 95% CI 1.2-1.8; p<0.001) and high dosages of edoxaban (RR: 1.22; 95% CI 1.01-1.47; p=0.038) and dabigatran (RR: 1.50; 95% CI 1.20-1.88; p<0.001) significantly increased gastrointestinal bleeding while a null effect was detected with apixaban. This meta-analysis suggests that rivaroxaban and high dosages of dabigatran and edoxaban should be avoided in patients at high risk of gastrointestinal bleeding.

References

Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Feb 1, 1996·Controlled Clinical Trials·A R JadadH J McQuay
Oct 6, 1997·BMJ : British Medical Journal·M EggerC Minder
Nov 2, 2002·BMJ : British Medical Journal·Gregory Y H LipDwayne S G Conway
Jun 7, 2007·Internal and Emergency Medicine·D FerroF Violi
Jan 1, 2010·The New England Journal of Medicine·Donald Stuart Houston, Ryan Zarychanski
Aug 9, 2011·Annual Review of Pharmacology and Toxicology·Jawed FareedDebra Hoppensteadt
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Mar 22, 2012·The Canadian Journal of Cardiology·Allan C SkanesUNKNOWN Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee
Aug 23, 2012·Circulation. Cardiovascular Quality and Outcomes·William L Baker, Olivia J Phung
Dec 20, 2012·Circulation. Arrhythmia and Electrophysiology·Francesco Violi, Lorenzo Loffredo
Jun 4, 2013·Gastrointestinal Endoscopy·Jay DesaiJames Aisenberg
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Nov 5, 2014·JAMA Internal Medicine·Inmaculada HernandezYuting Zhang

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Citations

Dec 15, 2015·Expert Review of Cardiovascular Therapy·Gualtiero Palareti, Daniela Poli
May 8, 2015·Thrombosis and Haemostasis·Christopher M Hillis, Mark A Crowther
Apr 14, 2016·Medicina clínica·Pedro Gil Gregorio
May 25, 2016·Internal and Emergency Medicine·Aaron Liew, James Douketis
Oct 4, 2016·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Emanuel RaschiFabrizio De Ponti
Oct 4, 2016·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Stavros StavrakisRalph Lazzara
Oct 30, 2016·Advanced Emergency Nursing Journal·Abby Mynatt BaileyStephanie Baker Justice
May 4, 2017·Expert Opinion on Drug Safety·Aitor Lanas-Gimeno, Angel Lanas
May 6, 2016·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·William Dager, Thaddaus Hellwig
Nov 1, 2017·MMW Fortschritte der Medizin·Markus Gosch
Apr 5, 2017·World Journal of Gastroenterology : WJG·Ka-Shing Cheung, Wai K Leung
Jul 28, 2020·Circulation Journal : Official Journal of the Japanese Circulation Society·Nobuhiro MurataUNKNOWN SAKURA AF Registry Investigators
Jun 22, 2021·TH Open : Companion Journal to Thrombosis and Haemostasis·Paolo Zappulla, Valeria Calvi

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