Effect of gastroprotective agents on upper gastrointestinal bleeding in patients receiving direct oral anticoagulants

Youn, Sung Hee; Lim, Hyun; Ju, Yeonmi; Soh, Jae Seung; Park, Ji Won; Kang, Ho Suk; Kim, Sung Eun; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee; Seo, Seung In; Shin, Woon Geon

doi:10.1080/00365521.2018.1541478

Cited by 8 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The indications for NOACs in the four studies were the prevention of stroke and systemic embolism in patients with atrial fibrillation or other patients who need prevention or treatment of acute vein thrombosis or pulmonary thromboembolism, while others only enrolled patients with atrial fibrillation. As for NOAC types, three studies focused only on dabigatran, while the other three studies also focused on other NOACs (rivaroxaban, apixaban, and edoxaban), 11,12,14 two of which performed subgroup analyses. 12,14 As for intervention, four studies enrolled patients undergoing PPIs or H2RAs co-therapy, and the other two studies included those who were concomitantly administered with PPIs, although none of them had further analyzed the two different types of acid suppressants or different types of PPIs.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Dong

et al. 2022

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Whether the use of acid suppressants can reduce non-vitamin K oral anticoagulants (NOACs)-related gastrointestinal bleeding (GIB) remains unclear. To systemically evaluate the effect of acid suppressants on the risk of GIB in patients treated with NOACs. All related studies were searched in four databases (Cochrane, Embase, PubMed, and Web of Science) from their establishment to August 10, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to identify studies and Stata 16.0 software was used for meta-analysis, including sensitivity and subgroup analysis. Six retrospective cohort studies were included in this study. The use of acid suppressants significantly reduced the GIB risk in patients taking NOACs, with an overall relative risk (RR) of 0.70 (95% confidence interval [CI]: 0.61-0.82; P < 0.001; I2 = 56.3%). This trend of reduced risk for GIB in NOACs was more significant in upper GIB (UGIB; RR: 0.45; 95%CI: 0.22-0.90; P = 0.025; I2 = 71.1%). The reduction was stronger for dabigatran than for rivaroxaban and apixaban. The least reduction in the risk of GIB with acid suppressant co-therapy was rivaroxaban (dabigatran: RR: 0.53; 95% CI: 0.45-0.62; P = <0.001; I2 = 39.8%; apixaban: RR: 0.67; 95% CI: 0.54-0.84; P = <0.001; I2 = 0; rivaroxaban: RR: 0.73; 95% CI: 0.66-0.81; P = <0.001; I2 = 37.6%). The included studies revealed the protective effect of acid suppressants against NOACs-related GIB, especially in the upper gastrointestinal tract. The protective effect was even stronger in patients using dabigatran than in those using Xa inhibitors (rivaroxaban and apixaban).

show abstract

Section: Resultsmentioning

confidence: 99%

“…Finally, six retrospective studies and only one RCT were identified. 8,[11][12][13][14][15][16] Considering the differences in study design, evaluation methods, and evidence levels between RCTs and retrospective studies, we included six retrospective studies in the final meta-analysis. 8,[11][12][13][14][15]…”

Section: Study Inclusionsmentioning

confidence: 99%

Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Dong

et al. 2022

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…The prescriptions for PPI and antacids prior to hospitalization were equally distributed in both groups. Although prophylactic prescription of PPIs can reduce the incidence of GIBs in high-risk patients receiving DOACs 29 , 95 patients (38.5%) did not receive a gastroprotective drug such as a PPI prior to hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal bleeding during anticoagulation with direct oral anticoagulants compared to vitamin K antagonists

Dongre

Schmid

Nussbaum

et al. 2022

gcsp

View full text Add to dashboard Cite

Aim: Patients receiving oral anticoagulants with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have an increased risk of gastrointestinal bleeding (GIB). We compared cases of GIB associated with VKAs and DOACs in terms of risk factors, scores, timing, location, severity, and outcome.Methods: Data from patients treated at a university hospital in Switzerland for GIB under VKA and DOACs between 2012 and 2018 were analyzed in this investigator-driven, retrospective, single-center study. Results: A total of 248 patients (110 males; median age, 80 years; 134 VKA, 114 DOAC) were included. No significant differences in age, weight or sex were observed. The propensity of the VKA group for risk factors such as comorbidities, interacting medications, or a high risk for bleeding (HAS-BLED score) was higher than that of the DOAC group. 56% of the VKA-treated patients had a supratherapeutic INR, and 25% in the DOAC group received an unlicensed dose. Significantly more patients in the DOAC group were not formally overdosed with OAC whilst receiving amiodarone compared to the VKA group (57% vs. 18%, respectively, p = 0.03). Latency between the documented start of oral anticoagulation and GIB was shorter in the DOAC group (median 3 months) than in the VKA group (median 23.5 months, p<0.001). There were no differences in terms of location and severity of the GIB, length of hospitalization, or mortality. Conclusion: Patients taking VKAs displayed more risk factors for GIB than those taking DOACs. Treatment with DOACs was associated with early GIB and calls for increased vigilance during the first months after commencement. Co-medication with amiodarone appeared to be a risk factor for GIB in patients taking DOACs.

show abstract

“…For example, PPIs can cause abdominal pain, nausea, headache, diarrhea, osteoporosis, and fractures, in addition to pneumonia, insomnia, and kidney inflammation ( Amang et al, 2017 ), and be associated with an increased gastric cancer risk ( Weltermann et al, 2021 ). The long-term use of H2Ras can lead to the development of galactorrhea in women, gynecomastia in men, and alteration of the bacterial flora of the gastrointestinal tract ( Youn et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…The use of PPIs and H2Ras can also lead to rapid tolerance during treatment, followed by a rebound effect of gastric hypersecretion after withdrawal of the drug, and ulcers may develop again ( Youn et al, 2018 ). Therefore, it is necessary to investigate new therapeutic alternatives with fewer adverse effects, which stimulate the ulcer healing process and prevent new relapses.…”

Section: Introductionmentioning

confidence: 99%

Gastric Ulcer Healing Property of Bryophyllum pinnatum Leaf Extract in Chronic Model In Vivo and Gastroprotective Activity of Its Major Flavonoid

et al. 2021

View full text Add to dashboard Cite

Gastric ulcer is a common disease that develops complications such as hemorrhages and perforations when not properly treated. Extended use of drugs in the treatment of this pathology can provoke many adverse effects. Therefore, finding medicinal plants with gastroprotective and mucosal healing properties has gained increasing interest. Bryophyllum pinnatum (Crassulaceae), popularly known in Brazil as “saião” or “coirama,” has been used to treat inflammatory disorders. It is rich in flavonoids, and quercetin 3-O-α-L-arabinopyranosyl-(1→2)-O-α-L-rhamnopyranoside-Bp1 is its major compound. In this study, we aimed to investigate ulcer healing properties of B. pinnatum against an acetic acid–induced chronic ulcer model and the gastroprotective activity of Bp1 against gastric lesions induced by ethanol and indomethacin. Ultrafast liquid chromatography was used to quantify the main compounds (mg/g of the extract)—quercetin 3-O-α-L-arabinopyranosyl-(1→2)-O-α-L-rhamnopyranoside (33.12 ± 0.056), kaempferol 3-O-α-L-arabinopyranosyl-(1→2)-O-α-L-rhamnopyranoside (3.98 ± 0.049), and quercetin 3-O-α-L-rhamnopyranoside (4.26 ± 0.022) and showed good linearity, specificity, selectivity, precision, robustness, and accuracy. In vivo studies showed that treatment with the extract at 250 and 500 mg/kg stimulated the healing process in the gastric mucosa with significant ulceration index reduction, followed by improvement in the antioxidant defense system [increased glutathione (GSH) levels, decreased superoxide dismutase upregulation, and malondialdehyde (MDA) levels]. Moreover, the extract decreased interleukin-1β and tumor necrosis factor-a levels and myeloperoxidase (MPO) activity, increased interleukin 10 levels, showed a cytoprotective effect in histological analyzes and also downregulated the expression of cyclooxygenase-2 and NF-κB (p65). The pretreatment with Bp1 at a dose of 5 mg/kg reduced gastric lesions in the ethanol and indomethacin models, increased GSH, and decreased MDA levels. In addition, the pretreatment decreased MPO activity, interleukin-1β and tumor necrosis factor-α levels, while also showing a cytoprotective effect in histological analyzes. Our study suggests that treatment with B. pinnatum extract showed a higher inhibition percentage than pretreatment with the Bp1. This might in turn suggest that Bp1 has gastroprotective activity, but other compounds can act synergistically, potentiating its effect. We conclude that B. pinnatum leaf extract could be a new source of raw material rich in phenolic compounds to be applied in food or medicine.

show abstract

Effect of gastroprotective agents on upper gastrointestinal bleeding in patients receiving direct oral anticoagulants

Cited by 8 publications

References 17 publications

Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Gastrointestinal bleeding during anticoagulation with direct oral anticoagulants compared to vitamin K antagonists

Gastric Ulcer Healing Property of Bryophyllum pinnatum Leaf Extract in Chronic Model In Vivo and Gastroprotective Activity of Its Major Flavonoid

Contact Info

Product

Resources

About