Direct-acting oral anticoagulants (DOACs) have recently been approved for stroke prevention in nonvalvular atrial fibrillation as well as venous thromboembolism cases. DOACs are increasingly preferred over warfarin due to predictable pharmacodynamics, lack of required monitoring and superior outcomes. DOACs are associated with an increased incidence of gastrointestinal (GI) bleeding compared with warfarin, but few data exist concerning the source and severity of the GI bleeding in patients treated with DOACs.

This retrospective study included the medical records of patients at the authors′ institution with GI bleeding (n＝8496) from 2010 through 2016. Of these, 61 patients had GI bleeding while being treated with DOACs and 123 while taking warfarin. These cases were compared to a control group of 296 patients with GI bleeding who were not receiving anticoagulation treatment.

Among the 480 patients studied, no significant difference was seen in the source of bleeding between the three groups (patients taking DOACs, warfarin or no anticoagulation). The DOAC group had fewer hospitalizations (P＝0.003) fewer days hospitalized (P＝0.007) and required fewer transfusions (P＝0.008) than did the warfarin group. The DOAC and control groups were not statistically different for all outcomes. No significant differences in mortality were found among the three groups.

Despite evidence showing a greater incidence of gastrointestinal bleeding in patients taking direct-acting oral anticoagulants (DOACs), as compared to those taking warfarin, this study suggests that such bleeding in patients taking DOACs may be less severe.