Hemorrhagic Events Associated With Direct Oral Anticoagulants: Frequency and Management

Background Direct oral anticoagulants (DOACs) have transformed anticoagulation strategies, yet bleeding complications remain a significant concern, particularly in elderly patients with polypharmacy. Methodology In this three-year, cross-sectional study conducted at a tertiary cardiology center in Morocco, we analyzed 35 cases of non-traumatic DOAC-related bleeding. Results The mean patient age was 67.5 years, and 89% were on multiple medications. Rivaroxaban was the most prescribed DOAC (74%), and gastrointestinal bleeding was the most common presentation (46%), followed by intracerebral hemorrhage and epistaxis (14% each). Major bleeding occurred in 34% of cases; however, no specific reversal agents were used. Despite resource limitations, outcomes were favorable in 94% of patients, with only two deaths recorded. Conclusions These real-world findings highlight the importance of individualized DOAC management, structured medication reviews, and improved access to reversal agents. In resource-limited settings, standardized protocols and clinician training are crucial to bridge the gap between guideline recommendations and everyday clinical practice.