Aloysius MM, Perisetti A, Goyal H, et al. - A lower risk of fatal gastrointestinal bleeding (GIB) was found to be associated with the use of direct-acting oral anticoagulants (DOACs) vs warfarin; this was particularly true in patients aged <60 years and those with poor coagulation control. However, a comparable GIB risk was conferred by warfarin and DOACs, except for rivaroxaban and dabigatran.

• A systematic review and meta-analysis was conducted.

• Randomized clinical trials (RCTs) that compared warfarin and DOACs for several indications (atrial fibrillation, thromboembolism, insertion of mechanical heart valves) were included.

• Any GIB event was the primary endpoint.

• 14 RCTs with 87,407 participants (DOACs n = 46,223, warfarin control n = 41,184) were analyzed.

• A higher risk of any GIB was noted with rivaroxaban and dabigatran vs warfarin.