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Direct-acting oral anticoagulants vs warfarin in relation to risk of gastrointestinal bleeding: A systematic review and meta-analysis of randomized controlled trials

Annals of Gastroenterology Aug 25, 2021

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.

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