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What gastroenterologists should know about direct oral anticoagulants.
Dig Liver Dis. 2020 Jun 09 [Online ahead of print]DL

Abstract

Direct oral anticoagulants are being increasingly used in patients with non-valvular atrial fibrillation and venous thromboembolism, due to their improved efficacy/ safety ratio, a predictable anticoagulant effect without need for routine coagulation monitoring, and fewer food and drug interactions compared with vitamin K antagonists. Gastrointestinal bleeding remains a serious complication, whose management is challenging for gastroenterologists due to the lack of a standardized clinical approach. Clinical experience on periendoscopic management of these drugs is still limited and there is a paucity of clinical data supporting guidelines recommendations', and this ultimately turns out in different, unsubstantiated and potentially harmful practices of patient management. Present study will provide a thorough revision on the risk of GI bleeding for DOAC therapy and the identification of patient risk factors to individualize treatment. Moreover, the approach to management of DOACs in case of bleeding complications is discussed, and an algorithm of different strategies in presence or not of plasma level measurement is proposed. Finally the periendoscopic management for elective procedures will be reviewed, at the light of the guideline recommendations and new evidences from observational studies.

Authors+Show Affiliations

Gastroenterology Department, Valduce Hospital, Como, Italy. Electronic address: francoradaelli@virgilio.it.Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.Gastroenterology Department, Valduce Hospital, Como, Italy.Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.Gastroenterology Service, Hôpital Civil Marie Curie, Charleroi, Belgium.Department of Medicine and Surgery, Insubria University, Varese, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32532603

Citation

Radaelli, F, et al. "What Gastroenterologists Should Know About Direct Oral Anticoagulants." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2020.
Radaelli F, Fuccio L, Paggi S, et al. What gastroenterologists should know about direct oral anticoagulants. Dig Liver Dis. 2020.
Radaelli, F., Fuccio, L., Paggi, S., Bono, C. D., Dumonceau, J. M., & Dentali, F. (2020). What gastroenterologists should know about direct oral anticoagulants. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. https://doi.org/10.1016/j.dld.2020.04.032
Radaelli F, et al. What Gastroenterologists Should Know About Direct Oral Anticoagulants. Dig Liver Dis. 2020 Jun 9; PubMed PMID: 32532603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What gastroenterologists should know about direct oral anticoagulants. AU - Radaelli,F, AU - Fuccio,L, AU - Paggi,S, AU - Bono,C Del, AU - Dumonceau,J M, AU - Dentali,F, Y1 - 2020/06/09/ PY - 2020/02/12/received PY - 2020/04/24/revised PY - 2020/04/26/accepted PY - 2020/6/14/pubmed PY - 2020/6/14/medline PY - 2020/6/14/entrez KW - Anticoagulation KW - Apixaban KW - DOACs KW - Dabigatran KW - Direct oral anticoagulants KW - Edoxaban KW - Gastrointestinal bleeding KW - Periprocedural management KW - Rivaroxaban JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis N2 - Direct oral anticoagulants are being increasingly used in patients with non-valvular atrial fibrillation and venous thromboembolism, due to their improved efficacy/ safety ratio, a predictable anticoagulant effect without need for routine coagulation monitoring, and fewer food and drug interactions compared with vitamin K antagonists. Gastrointestinal bleeding remains a serious complication, whose management is challenging for gastroenterologists due to the lack of a standardized clinical approach. Clinical experience on periendoscopic management of these drugs is still limited and there is a paucity of clinical data supporting guidelines recommendations', and this ultimately turns out in different, unsubstantiated and potentially harmful practices of patient management. Present study will provide a thorough revision on the risk of GI bleeding for DOAC therapy and the identification of patient risk factors to individualize treatment. Moreover, the approach to management of DOACs in case of bleeding complications is discussed, and an algorithm of different strategies in presence or not of plasma level measurement is proposed. Finally the periendoscopic management for elective procedures will be reviewed, at the light of the guideline recommendations and new evidences from observational studies. SN - 1878-3562 UR - https://www.unboundmedicine.com/medline/citation/32532603/What_gastroenterologists_should_know_about_direct_oral_anticoagulants L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(20)30187-0 DB - PRIME DP - Unbound Medicine ER -
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