title: The risk of gastrointestinal bleeding in patients receiving dabigatran etexilate: a systematic review and meta-analysis of the literature.
abstract: Evidence on the risk of gastrointestinal (GI) bleeding associated with dabigatran etexilate (DE) is contrasting. We performed a meta-analysis of literature to address this issue.
  
  
  
  Studies on GI bleeding risk in patients receiving DE or vitamin-K antagonists (VKA) were systematically searched. Twenty-three studies (26 datasets) showed no difference in the GI bleeding risk between the 250,871 patients treated with DE and the 460,386 receiving VKA (OR: 1.052, 95% CI: 0.815, 1.359). Similar results were obtained when pooling together adjusted ORs/HRs, obtained by means of multivariate analysis (OR: 1.06, 95% CI: 0.914, 1.222). Compared with VKA, DE use was associated with a significantly lower risk of upper GI (OR: 0.742, 95% CI: 0.569, 0.968), but not of lower GI bleedings (OR: 1.208, 95% CI: 0.902, 1.619). Furthermore, no significant difference in the GI bleeding risk was found when data on DE 110 mg and DE 150 mg twice-daily were separately compared with VKA.
  
  
  
  No difference in GI bleeding risk was found between DE and VKA. These results were confirmed for both dosages of DE and when specifically analyzing lower GI bleeding. In contrast, the risk of upper GI bleeding was lower with DE than with VKA. KEY MESSAGES No difference in the risk of gastrointestinal (GI) bleeding can be found between dabigatran etexilate (DE) and vitamin K-antagonists (VKA). These results are confirmed for both dosages of DE. The risk of upper GI bleeding is lower with DE than with VKA.
authors.affiliation: a Department of Advanced Biomedical Sciences, Division of Cardiology , Federico II University , Naples , Italy.|b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.affiliation: c Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
authors.affiliation: b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.affiliation: b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.affiliation: c Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects*; D000069604:Dabigatran / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000991:Antithrombins; D014812:Vitamin K; D000069604:Dabigatran
keywords: Anticoagulants; bleeding; dabigatran etexilate; gastrointestinal hemorrhage; hemorrhage