Key result
DOAC-associated lower GI bleeding carries ~57% recurrent hospital admissions.
Why the study?
Current data describing investigation, transfusion requirements, anticoagulant management, and recurrence after DOAC-associated lower gastrointestinal bleeding remains limited.
Cohort (n=99)
No
DOAC-associated lower gastrointestinal bleeding generally settles with conservative management but is associated with a high rate of recurrent bleeding admissions.
Aims Direct oral anticoagulants (DOACs) are widely prescribed and are associated with gastrointestinal bleeding. Current data describing investigation, transfusion requirements, anticoagulant management and recurrence after DOAC-associated lower gastrointestinal bleeding (LGIB) remains limited. Methods We performed a single-centre retrospective cohort study at a district general hospital from 2018 to 2026. Patients were included if admitted with LGIB while prescribed a DOAC. Outcomes included red cell transfusion, inpatient investigation, transfer for embolisation, anticoagulant interruption, length of stay and recurrent LGIB admissions. Results 99 patients were included with a median age of 82 years and a mean Charlson Comorbidity index of 5.8. The recorded DOAC’s were edoxaban in 49.5%, apixaban in 43.4% and rivaroxaban in 7.1%. Median length of stay was 4 days (IQR 3–6.3). Transfusion was given in 26.3% patients, with a median of 2 units per patient. Endoscopy was performed in 27.3% patients, with inpatient being 16.2%, and outpatient being 17.2% of total patients. CT angiography was performed in 10.1%, only 1 patient required transfer for embolisation. DOAC therapy was paused in admission in all cases, and the median hold duration was 5 days (IQR 3–9). Restart by discharge was documented in 57.6% and discontinuation in 15.2%. Recurrent LGIB admission was recorded in 56.6% of patients. Conclusions DOAC-associated LGIB predominantly affected older patients, with substantial transfusion and high recurrence. Investigation and anticoagulant management varied, highlighting the need for structured short-term and long term management pathways. Reassuringly, in hospital outcomes of DOAC associated LGIB nearly always settled with conservative measures.
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Biswas et al. (2026) conducted a cohort in Lower gastrointestinal bleeding (LGIB) (n=99). Direct oral anticoagulants (DOACs) was evaluated on Red cell transfusion, inpatient investigation, transfer for embolisation, anticoagulant interruption, length of stay and recurrent LGIB admissions. Among 99 patients with DOAC-associated lower gastrointestinal bleeding, 26.3% required red cell transfusion and 56.6% experienced recurrent admissions, with 57.6% restarting DOACs by discharge.
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