title: Patient Taking A Novel Oral Anticoagulant Presents With Major GI Bleeding.
abstract: Novel Oral Anticoagulants (NOACs) such as Dabigatran, Rivaroxaban, Apixaban and Edoxaban are becoming increasingly popular choices for anticoagulation in place of oral Vitamin K Antagonists in various clinical settings. However, they are thought to be associated with an increased risk of gastrointestinal bleeding. Moreover, no specific antidote is available which can rapidly reverse the anti-coagulant action of NOACs raising concern that gastrointestinal bleeding with NOACs could carry a worse prognosis than that associated with conventional agents. In this review, we describe a case of gastrointestinal bleeding in the setting of NOAC use, followed by a brief overview of the pivotal trials involving NOACs. Clinical issues such as pathophysiology, diagnosis and management of NOAC induced GI bleeding have been described. Future trials will help elucidate the true incidence, risk factors and preventive strategies for NOAC associated gastrointestinal bleeding.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Department of Medicine, St. Michael's Medical Center, Newark, NJ, USA.
authors.forename: Parijat
authors.initials: P
authors.lastname: Sen
authors.affiliation: Division of Cardiology, St. Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, NY, USA.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Huston
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Ryan
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
keywords: Apixaban; Dabigatran; Edoxaban; Gastrointestinal Bleeding; Novel Oral Anticoagulants; Rivaroxaban