Complications of Pharmacotherapy with New Oral Anticoagulants Caused by Inter-Drug Interactions: Focus on Gastrointestinal Bleeding

New oral  anticoagulants are  effective for  the  prevention of thromboembolic complications in patients with atrial fibrillation, or after orthopedic surgery. The use  of these drugs may be associated with the  risk of bleeding from the  gastrointestinal tract — a dangerous complication, which can potentially lead  to death. The aim of this research was systematization and analysis of information on the interactions of new oral anticoagulants with other drugs and food products, and  the  identification of potentially dangerous combinations that increase the  risk of gastrointestinal bleeding. To assess the  risk of a heavy bleeding in patients with atrial fibrillation taking oral  anticoagulants to  prevent thromboembolic complications, HAS-BLED scale  is used. In some  cases  activated partial thromboplastin time, ecarin clotting time, anti-FXa, etc. can  be used  to assess the  effectiveness of the  oral  anticoagulants. Potential combinations that increase the  risk of  bleeding include the  simultaneous administration of  new  oral  anticoagulants with antiplatelet agents, anticoagulants, including vitamin K antagonists, unfractionated heparin, low molecular weight heparins, nonsteroidal anti-inflammatory drugs, antidepressants along with other drugs and foods (curcumin, grapefruit juice, peppermint, eucalyptus, etc.). The administration of proton pump inhibitors, as well  as the  elimination of potentially dangerous combinations of drugs and  food with new oral  anticoagulants, can help  prevent gastrointestinal bleeding.

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