On the treatment of new oral anticoagulant-associated gastrointestinal hemorrhage

The recently introduced new oral anticoagulants (nOAC) carry a higher gastrointestinal bleeding risk compared to traditional antithrombotic therapy. Current diagnostic coagulation tests are not accurate enough to determine the level of coagulopathy. Besides that, the lack of a specific antidote leaves the endoscopist unsure how to achieve hemostasis during gastrointestinal hemorrhage. In this brief report, we address the (endoscopic) management, when facing a suspected nOAC-associated gastrointestinal hemorrhage. We recommend that specific coagulation tests such as diluted thrombin time and anti-Xa measurement should be made available. Furthermore, nOAC should be stopped. Finally, correcting coagulopathy with administration of prothrombin complex concentrate, recombinant factor VIIa and even hemodialysis should be considered, whereas fresh frozen plasma and vitamin K have no place. The generalizability of these recommendations needs to be confirmed in future studies.