Vnitr Lek 2025, 71(7):443-450 | DOI: 10.36290/vnl.2025.080

Risk of gastrointestinal bleeding with oral anticoagulants: actual review and influencing factors

Antonín Bartusek¹, Radek Kroupa²

¹ Interní a kardiologická klinika, Oddělení gastroenterologie, FN Ostrava

² Interní gastroenterologická klinika, LF MU a FN Brno

Gastrointestinal bleeding is the most common bleeding complication in users of oral anticoagulants and is associated with significant morbidity and mortality. Warfarin is gradually being replaced by direct thrombin inhibitors (dabigatran etexilate) and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban). Total number of users of all oral anticoagulants increased by 60% during last 10 years. Conclusions from early randomized controlled trials showed a 23-60 % higher risk of gastrointestinal bleeding in users of direct oral anticoagulants compared to warfarin. Recent meta­‑analyses and observational studies from real­‑world clinical practice showed that the risk of bleeding with direct oral anticoagulants as a whole is not too different from warfarin, but depends on the type and dose of the drug. It is relatively lowest at low doses of edoxaban. Concomitant use of proton pump inhibitors slightly reduced the risk of upper gastrointestinal bleeding, more significantly with warfarin, dabigatran, and in high­‑risk patients, by up to 24-44 %. To reduce the risk of bleeding, it is recommended to discontinue oral anticoagulants for high­‑risk endoscopic procedures. In era of increasing prescription of oral anticoagulants, it is essential to reduce the risk of bleeding by selection the appropriate medication on an individual basis and adjustment of dosage according to the patient's condition and specific clinical situation.

Keywords: direct oral anticoagulants, gastrointestinal bleeding, oral anticoagulants, warfarin.

Accepted: October 16, 2025; Published: October 31, 2025  Show citation