• Thomas Vanassche, Jack Hirsh, John W Eikelboom, and Jeffrey S Ginsberg.
• John Eikelboom, 237 Barton Street East, Hamilton, ON, L9K 1H8, Canada, Tel.: +1 905 527 4322 ext 40323, Fax: +1 905 521 1551, E-mail: eikelbj@mcmaster.ca.
• Thromb Haemostasis. 2014 Nov 1;112(5):918-23.

AbstractAnticoagulants 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.

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