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

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.
AuthorsThomas Vanassche, Jack Hirsh, John W Eikelboom, Jeffrey S Ginsberg
JournalThrombosis and haemostasis (Thromb Haemost) Vol. 112 Issue 5 Pg. 918-23 (Nov 2014) ISSN: 0340-6245 [Print] Germany
PMID25187203 (Publication Type: Comparative Study, Journal Article, Review)
Chemical References
  • Anticoagulants
  • Blood Coagulation Factors
  • Factor Xa Inhibitors
  • Vitamin K
  • Warfarin
  • Thromboplastin
  • 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)

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