Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Biomed Res Int. 2018 May 15;2018:7123607. doi: 10.1155/2018/7123607. eCollection 2018.
Nonvitamin K oral anticoagulants (NOACs) sometimes cause hemorrhage, and the gastrointestinal tract is a common site of involvement. However, clinical characteristics of gastrointestinal bleeding (GIB) during NOAC therapy have not been fully elucidated. We studied 658 patients who were prescribed dabigatran, rivaroxaban, or apixaban between April 2011 and November 2015. Medical charts were reviewed to examine whether clinically relevant bleeding (Bleeding Academic Research Consortium criteria type 2 or greater) developed. The incidence of GIB was 2.0%/year, and one-third was from the upper GI. Among all hemorrhagic events, GIB was the most common cause. The extent of bleeding from the GI tract, particularly the upper GI tract, was more serious than bleeding from the other site. Multiple regression analysis showed that both past digestive ulcer and absence of concomitant proton pump inhibitors were significantly associated with the incidence of upper GIB, while concomitant nonsteroidal anti-inflammatory drugs, dual antiplatelets, and past GIB were significant factors regarding lower GIB. GIB was common and serious in patients taking NOACs. Upper GIB tended to become more serious than lower GIB. Proton pump inhibitors seem to be key drugs for preventing upper GIB during NOAC therapy.
非维生素 K 口服抗凝剂（NOACs）有时会引起出血，胃肠道是常见的受累部位。然而，NOAC 治疗期间胃肠道出血（GIB）的临床特征尚未完全阐明。我们研究了 2011 年 4 月至 2015 年 11 月期间服用达比加群、利伐沙班或阿哌沙班的 658 名患者。回顾病历以检查是否出现临床相关出血（Bleeding Academic Research Consortium 标准 2 级或更高级别）。GIB 的发生率为 2.0%/年，其中三分之一来自上胃肠道。在所有出血事件中，GIB 是最常见的原因。胃肠道出血的严重程度，特别是上胃肠道出血，比其他部位更严重。多因素回归分析显示，既往消化性溃疡和未同时使用质子泵抑制剂与上胃肠道 GIB 的发生率显著相关，而同时使用非甾体抗炎药、双重抗血小板治疗和既往 GIB 是下胃肠道 GIB 的显著相关因素。NOAC 治疗期间，GIB 在服用 NOAC 的患者中很常见且严重。上胃肠道 GIB 往往比下胃肠道 GIB 更严重。质子泵抑制剂似乎是预防 NOAC 治疗期间上胃肠道 GIB 的关键药物。
