Key result
DOACs linked to ~29% lower odds of severe GI bleeding vs. VKAs.
Why the study?
It remained undetermined whether gastrointestinal bleeding associated with direct oral anticoagulants or vitamin K antagonists is more severe.
Do direct oral anticoagulants reduce the severity of gastrointestinal bleeding compared to vitamin K antagonists in patients with atrial fibrillation?
Cohort (n=6,784)
Yes
Do direct oral anticoagulants reduce the severity of gastrointestinal bleeding compared to vitamin K antagonists in patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
In patients with atrial fibrillation who experience gastrointestinal bleeding, prior use of DOACs is associated with less severe bleeding and fewer endoscopies compared to vitamin K antagonists.
BACKGROUND: It remains undetermined whether gastrointestinal bleeding (GIB) associated with direct oral anticoagulant (DOAC) or vitamin K antagonists (VKA) is more severe. METHODS: In Danish nationwide registries, we identified patients with atrial fibrillation (AF) treated with anticoagulation with gastrointestinal bleeding (GIB). Logistic regression models were used to compare GIB severity between DOAC and VKA users, defined by 1. red blood cell transfusion or in-hospital death and 2. endoscopies. RESULTS: From 2012-2018, 6,784 anticoagulated AF patients with GIB were identified; 3,724 patients VKA users and 3,060 DOAC (apixaban, dabigatran or rivaroxaban) users. The proportion of upper GIB was 49% in VKA users and 40.1% in DOAC users. Blood transfusions were administered to 58.2% and 43.8-48.9% of patients with VKA and DOAC, respectively. Odds ratios (OR, adjusted for age, sex, and comorbidities) for severe GIB were significantly reduced for all DOACs compared to VKA (apixaban 0.71 (95% confidence interval (CI) 0.59-0.85), dabigatran 0.64 (95% CI 0.55-0.75) and rivaroxaban 0.69 (95% CI 0.59-0.81)). Odds for endoscopy was significantly reduced in apixaban (OR 0.77 (95% CI 0.65-0.90) and dabigatran (OR 0.81 (95% CI 0.71-0.93) compared to VKA, and borderline reduced for rivaroxaban (OR 0.88 (95% CI 0.77-1.02)). In patients with upper GIB, compared to VKA the use of gastroscopy was significantly reduced for apixaban (0.68 (95% CI 0.53-0.87)) but not for dabigatran or rivaroxaban. CONCLUSION: VKA use was associated with more severe GIB and more frequent endoscopies compared to DOAC. Future studies should identify subgroups at particular risk of severe GIB.
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Christiansen et al. (2026) conducted a cohort in Atrial fibrillation with gastrointestinal bleeding (n=6,784). Direct oral anticoagulants (apixaban, dabigatran, or rivaroxaban) vs. Vitamin K antagonists (VKA) was evaluated on Severe gastrointestinal bleeding (defined by red blood cell transfusion or in-hospital death) (OR 0.71 (apixaban), 0.64 (dabigatran), 0.69 (rivaroxaban), 95% CI 0.59-0.85 (apixaban), 0.55-0.75 (dabigatran), 0.59-0.81 (rivaroxaban)). Direct oral anticoagulants were associated with significantly reduced odds of severe gastrointestinal bleeding compared to vitamin K antagonists (e.g., apixaban OR 0.71; 95% CI 0.59-0.85).
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