Gastrointestinal Bleeding Due to NOACs Use: Exploring the Molecular Mechanisms

Novel oral anticoagulants (NOACs) are drugs approved for the prevention and treatment of many thromboembolic cardiovascular conditions as a safer alternative to warfarin. We reviewed studies published in PubMed(R), UpToDate(R), Web of Science(R), and Cochrane(R) about NOACs' risks and benefits in patients requiring anticoagulation, with a focus on gastrointestinal bleeding and on molecular and pathophysiological mechanisms underlying the risk of bleeding in patients treated with them. Apixaban resulted in a lower rate of gastrointestinal bleeding compared to dabigatran and rivaroxaban. However, data reported that gastrointestinal bleeding in patients treated with NOACs was less severe compared to warfarin. Studies show promising results on the increased and widespread use of NOACs in patients who require anticoagulation (for example-in case of atrial fibrillation or high risk of venous thromboembolism), reporting an overall lower risk of major bleeding events. The profile of NOACs was more effective and secure compared to warfarin, but a more careful medical prescription is required in patients who are at high risk of gastrointestinal bleeding.

Automated summary

NOACs are a safer alternative to warfarin for the prevention and treatment of thromboembolic cardiovascular conditions. Studies have shown that apixaban has a lower rate of gastrointestinal bleeding compared to dabigatran and rivaroxaban, and gastrointestinal bleeding in patients treated with NOACs is generally less severe than with warfarin. The use of NOACs is increasing and widespread in patients who require anticoagulation, with an overall lower risk of major bleeding events. However, caution is still needed in patients at high risk of gastrointestinal bleeding.