Severity of gastrointestinal bleeding is similar for patients receiving direct oral anticoagulants and patients receiving vitamin K antagonists

Background: gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. Aim: to evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. Methods: patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcomes were obtained from medical records. GIB severity was classified as mild, major, or severe according to the clinical presentation and type of support needed. Etiology and location of bleeding, number of packed red blood cells (PRBC) transfused, and length of hospital stay were recorded until discharge or in-hospital death. Results: a total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC, with similar characteristics. Thirty-one patients had severe GIB; 134 had major and 43 had mild GIB, with no differences in severity, number of PRBC, and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6 %, p = 0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3 % vs. 24.8 %, p = 0.056). Conclusions: severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of GIB etiology. Keywords: Gastrointestinal bleeding. Direct oral anticoagulants. Vitamin K antagonists. Rivaroxaban. Dabigatran. Apixaban. Edoxaban.