Organ-specific bleeding patterns of anticoagulant therapy: lessons from clinical trials.

Abstract

Anticoagulants are effective at preventing and treating thrombosis, but can cause bleeding. For decades, vitamin K antagonists (VKAs) have been the only available oral anticoagulants. The development of non-VKA oral anticoagulants (NOACs), which inhibit either factor Xa or thrombin stoichiometrically, has provided alternatives to VKAs for several indications. The results of recent large-scale randomised controlled trials comparing NOACs with VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation (AF) have produced some unexpected results. As a group, NOACs showed similar efficacy as warfarin, but a reduced risk of major bleeding. The reduction in bleeding with NOACs was greatest with intracranial hemorrhage. In contrast, the relative risk of gastro-intestinal bleeding was increased with some NOACs. In this review, we explore the potential mechanisms as well as the implications of these organ-specific bleeding patterns.

• Authors: Thomas Vanassche, Jack Hirsh, John W Eikelboom, Jeffrey S Ginsberg
• Journal: Thrombosis and haemostasis (Thromb Haemost) Vol. 112 Issue 5 Pg. 918-23 (Nov 2014) ISSN: 2567-689X [Electronic] Germany
• PMID: 25187203 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Anticoagulants
• Blood Coagulation Factors
• Factor Xa Inhibitors
• Vitamin K
• Warfarin
• Thromboplastin

Topics

• Anticoagulants (adverse effects, pharmacokinetics, therapeutic use)
• Atrial Fibrillation (complications)
• Blood Coagulation Factors (physiology)
• Endothelium, Vascular (physiopathology)
• Factor Xa Inhibitors (adverse effects, pharmacokinetics, therapeutic use)
• Gastrointestinal Hemorrhage (chemically induced, physiopathology, prevention & control)
• Hemorrhage (chemically induced)
• Humans
• International Normalized Ratio
• Intestinal Absorption
• Intracranial Hemorrhages (chemically induced, physiopathology, prevention & control)
• Organ Specificity
• Randomized Controlled Trials as Topic
• Stroke (prevention & control)
• Thrombophilia (drug therapy, etiology)
• Thromboplastin (physiology)
• Vitamin K (antagonists & inhibitors)
• Warfarin (adverse effects, therapeutic use)