Systematic review with meta-analysis: the risk of major gastrointestinal bleeding with non-vitamin K antagonist oral anticoagulants

被引:47
作者
Caldeira, D. [1 ,2 ,3 ]
Barra, M. [1 ]
Ferreira, A. [1 ]
Rocha, A. [1 ]
Augusto, A. [1 ]
Pinto, F. J. [4 ]
Costa, J. [1 ,2 ,5 ,6 ]
Ferreira, J. J. [1 ,2 ]
机构
[1] Inst Med, Clin Pharmacol Unit, Lisbon, Portugal
[2] Univ Lisbon, Fac Med, Lab Clin Pharmacol & Therapeut, P-1649028 Lisbon, Portugal
[3] Hosp Garcia Orta, Dept Cardiol, Almada, Portugal
[4] CAML, CCUL, Fac Med, Dept Cardiol, Lisbon, Portugal
[5] Univ Lisbon, Fac Med, Ctr Evidence Based Med, P-1649028 Lisbon, Portugal
[6] Univ Lisbon, Fac Med, IberoAmer Cochrane Network, Portuguese Collaborating Ctr, P-1649028 Lisbon, Portugal
关键词
RIVAROXABAN VS. WARFARIN; ATRIAL-FIBRILLATION; VENOUS THROMBOEMBOLISM; DABIGATRAN ETEXILATE; DOUBLE-BLIND; ENOXAPARIN; APIXABAN; THROMBOPROPHYLAXIS; PREVENTION; ARTHROPLASTY;
D O I
10.1111/apt.13412
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BackgroundGastrointestinal (GI) bleeding is a common complication among anticoagulated patients. Non-vitamin K antagonist oral anticoagulants (NOACs) are associated with increased risk of GI (major and clinically relevant non-major) bleeding. However, more information is needed regarding severe events. AimTo evaluate the risk of NOACs major GI bleeding. MethodsWe searched for phase III randomised clinical trials (RCT) evaluating NOACs (apixaban, dabigatran, edoxaban and rivaroxaban) and reporting major GI bleeding events, in MEDLINE, Cochrane Library, SciELO collection and Web of Science databases (July 2015). Meta-analysis was performed to estimate risk ratio (RR) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with the I-2 test. ResultsA total of 23 studies were included. Among patients with atrial fibrillation, the risk of major GI bleeding was not different between NOACs and vitamin K antagonists (VKA) (RR 1.08, 95% CI 0.85-1.36, I-2=78%; 5 RCTs) or acetylsalicylic acid (RR 0.78, 95% CI 0.36-1.72; 1 RCT). Similar results were found for patients undergoing orthopaedic surgery and those with venous thromboembolism. NOACs were not found to increase the risk compared to low-molecular-weight heparin (LWMH) alone (RR 1.42, 95% CI 0.55-3.71, I-2=7%; 8 RCTs), the sequential treatment with LMWH-VKA (RR 0.77, 95% CI 0.49-1.21, I-2=43%; 7 RCTs) or placebo (RR 1.48, 95% CI 0.15-14.84, I-2=21%; 2 RCTs). ConclusionDespite previous evidence supporting the association of non-vitamin K antagonist oral anticoagulants and overall GI bleeding, non-vitamin K antagonist oral anticoagulants are not associated with increased risk of major GI bleeding compared to other anticoagulant drugs (with known increased risk of these events).
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页码:1239 / 1249
页数:11
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