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Thromb Haemost 2014; 112(05): 918-923
DOI: 10.1160/th14-04-0346
Theme Issue Article
Schattauer GmbH

Organ-specific bleeding patterns of anticoagulant therapy: lessons from clinical trials

Thomas Vanassche
1   Population Health Research Institute, Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
,
Jack Hirsh
1   Population Health Research Institute, Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
,
John W. Eikelboom
1   Population Health Research Institute, Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
,
Jeffrey S. Ginsberg
1   Population Health Research Institute, Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received: 11 April 2014

Accepted after major revision: 10 July 2014

Publication Date:
29 November 2017 (online)

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Summary

Anticoagulants are effective at preventing and treating thrombosis, but can cause bleeding. For decades, vitamin K antagonists (VKAs) have been the only available oral anticoagulants. The development of non-VKA oral anticoagulants (NOACs), which inhibit either factor Xa or thrombin stoichiometrically, has provided alternatives to VKAs for several indications. The results of recent large-scale randomised controlled trials comparing NOACs with VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation (AF) have produced some unexpected results. As a group, NOACs showed similar efficacy as warfarin, but a reduced risk of major bleeding. The reduction in bleeding with NOACs was greatest with intracranial hemorrhage. In contrast, the relative risk of gastro-intestinal bleeding was increased with some NOACs. In this review, we explore the potential mechanisms as well as the implications of these organ-specific bleeding patterns.

Keywords

Venous thrombosis - stroke prevention - thrombosis
 

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