Gastrointestinal protection options for direct oral anticoagulants in patients with atrial fibrillation

Abstract

Gastrointestinal bleeding (GIB) associated with the use of direct oral anticoagulants or, as they are also called, new oral anticoagulants (NOAC) is a serious medical problem, the relevance of which will only increase taking into account the constant expansion of the use of anticoagulants. It is especially important that most of the patients receiving NOAC are elderly people with multiple concomitant pathologies, including diseases of the gastrointestinal tract (GI), which makes them classified as patients with a high risk of GIB and, therefore, in need of prescribing gastroprotectors to protect the GI mucosa and prevent GIB. Considering that one of the mechanisms of GIB development during NOAC therapy is associated with their ability to inhibit GI mucosa healing, and the NOAC themselves are factors of aggression for GI and can lead to syndrome of increased epithelial permeability, the use of gastro- and the enteroprotector of rebamipide seems appropriate and probably pathogenetically justified. The randomized REGATA trial initiated at the Russian Gerontological Research and Clinical Center will provide additional information on the use of rebamipide in patients with atrial fibrillation receiving various NOAC.

Keywords

• direct oral anticoagulants
• gastrointestinal tract
• gastrointestinal bleeding
• syndrome of increased epithelial permeability
• rebamipide