Gastrointestinal bleeding during treatment with nonvitamin K antagonist oral anticoagulants (NOACs) may be caused by malignant lesions
Haeggström, A.; Risberg, D.; Al-Kahlili, F.; Gilstring, Åsa.; Tullberg, U.; Wallén, Håkan.
Lakartidningen 113
2016
ISSN/ISBN: 0023-7205 PMID: 27824386 Document Number: 690917
Gastrointestinal bleeding during treatment with non -vitamin K antagonist oral anticoagulants (NOACs) may be caused by malignant lesions Gastrointestinal bleeding due to underlying malignancy may not be uncommon in real life patients on non vitamin K antagonist oral anticoagulants (NOACs) like dabigatran, rivaroxaban or apixaban. We performed a small pilot study in patients referred to endoscopy due to suspected gastrointestinal bleeding. In twenty NOAC-treated patients, we found four cases of manifest malignant colon tumors, one premalignant colon adenoma, and one gastric B-cell lymphoma. All lesions were previously unknown and non-symptomatic apart from suspected gastrointestinal bleeding. Endoscopy should be performed in patients on NOACs with signs or suspicions of gastrointestinal bleeding. Whether a fecal occult blood test should be incorporated in the follow-up of patients on NOAC treatment deserves to be investigated in future studies.