From the Guidelines
The most common side effects of oral Direct Oral Anticoagulants (DOACs) are bleeding events, including major bleeding and clinically relevant non-major bleeding.
Common Side Effects
- Gastrointestinal bleeding: increased risk with DOACs, particularly with edoxaban and rivaroxaban 1
- Intracranial hemorrhage: reduced risk with DOACs compared to warfarin 1
- Major bleeding: increased risk with DOACs in patients with GI malignancies and unresected mucosal tumors or active mucosal lesions 1
Less Common Side Effects
- Thrombocytopenia: potential risk factor for bleeding with DOACs 1
- Nausea and vomiting: may impact adherence with DOACs due to their oral route of administration 1
Important Considerations
- Drug-drug interactions: potential interactions between DOACs and anticancer treatments, including chemotherapeutic agents, hormonal therapy, and immunotherapy 1
- Renal or hepatic impairment: caution warranted when using DOACs in patients with these conditions due to increased risk of bleeding 1
From the Research
Side Effects of Oral DOACs
The side effects of oral Direct Oral Anticoagulants (DOACs) are a crucial consideration in their use. Some of the key side effects include:
- Bleeding, which is the most prominent complication of these agents 2
- Major intracranial hemorrhages, which have similar or lower rates compared to warfarin 2
- Major gastrointestinal bleeding, which has a higher risk compared to warfarin 2, 3
- All-cause mortality, which is comparable to warfarin 4
Bleeding Risks
The risk of bleeding with DOACs is a significant concern. Factors that affect the risk of bleeding include:
- Patient characteristics, such as renal impairment, comedications, and age 3
- The specific DOAC used, with different agents having different bleeding risks 4, 2
- The dose and duration of treatment 5
Management of Bleeding
In the event of bleeding, management strategies include:
- Aggressive interventions for severe bleeding episodes 2
- Evaluation of the location and rate of hemorrhage, and total volume of blood loss 2
- Use of specific reversal agents, such as idarucizumab and andexanet alfa, if available 2
- Use of nonspecific prohemostatic agents, such as prothrombin complex concentrates and fresh frozen plasma, in the management of DOAC-related bleeding diathesis 2, 3