Department of Gastroenterology and Hepatology, University of Colorado Hospital, Denver, CO, USA.
Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Dig Dis Sci. 2018 Jul;63(7):1878-1889. doi: 10.1007/s10620-018-5007-6. Epub 2018 Mar 27.
Different oral anticoagulants may be associated with gastrointestinal bleeding (GIB) from different locations or mucosal lesions. We aimed to test this hypothesis.
Two blinded gastroenterologists independently analyzed source documents from the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial of dabigatran 150 mg BID (D150), dabigatran 110 mg BID (D110) versus warfarin in non-valvular atrial fibrillation (NVAF).
Major GIB events (total n = 546) and life-threatening GIB events (n = 258) were more common with D150 versus warfarin (RR 1.57 [1.28-1.92] and RR 1.62 [1.20-2.18], respectively) and similar for D110 compared to warfarin (RR 1.11 [0.89-1.38] and RR 1.16 [0.84-1.61], respectively). Fatal bleeding was similarly rare across treatment groups. Lower GI major bleeding and life-threatening bleeding were more common with D150 compared to warfarin (RR 2.23 [1.47, 3.38] and RR 2.64 [1.36, 5.13], respectively) and with D110 compared to warfarin (RR 1.78 [1.16, 2.75] and RR 2.00 [1.00, 4.00], respectively). MGIB from colonic angiodysplasia was increased with dabigatran versus warfarin (P < 0.01 for both dose comparisons). Subacute and chronic MGIB events were more common with D150 than with warfarin (RR 1.72 [1.06, 2.78] and RR 1.66 [1.12, 2.45], respectively), as were hematochezia or melena (RR 1.67 [1.18, 2.36] and RR 1.72 [1.20, 2.47], respectively).
In a chronic NVAF population, D150 but not D110 is associated with increased major and life-threatening GI bleeding in comparison with warfarin. At both dabigatran doses, increased bleeding from the colorectum, in particular from angiodysplasia, is seen.
不同的口服抗凝剂可能与胃肠道出血（GIB）的不同部位或黏膜病变有关。我们旨在验证这一假设。
两名盲法胃肠病学家独立分析了来自非瓣膜性心房颤动（NVAF）的达比加群 150mg BID（D150）、达比加群 110mg BID（D110）与华法林的随机评估长期抗凝治疗（RE-LY）试验的原始文件。
与华法林相比，D150 发生主要 GIB 事件（总 n=546）和危及生命的 GIB 事件（n=258）更为常见（RR 1.57[1.28-1.92]和 RR 1.62[1.20-2.18]），D110 与华法林相比也相似（RR 1.11[0.89-1.38]和 RR 1.16[0.84-1.61]）。治疗组之间同样罕见致命性出血。与华法林相比，D150 发生下消化道主要出血和危及生命的出血更为常见（RR 2.23[1.47,3.38]和 RR 2.64[1.36,5.13]），D110 也更为常见（RR 1.78[1.16,2.75]和 RR 2.00[1.00,4.00]）。与华法林相比，达比加群导致结肠血管发育不良的 MGIB 增加（两种剂量比较均 P<0.01）。与华法林相比，D150 发生亚急性和慢性 MGIB 事件更为常见（RR 1.72[1.06,2.78]和 RR 1.66[1.12,2.45]），血便或黑便也更为常见（RR 1.67[1.18,2.36]和 RR 1.72[1.20,2.47]）。
在慢性 NVAF 人群中，与华法林相比，D150 而非 D110 与主要和危及生命的胃肠道出血增加相关。在达比加群的两种剂量下，均可见来自结直肠的出血增加，特别是来自血管发育不良的出血。
