Pharmacotherapy

DOACs safer than warfarin after GI bleed in afib patients resuming anticoagulation

September 2, 2025

Study details: This retrospective cohort study analyzed 4,389 adults with afib who were hospitalized for major GI bleeding (GIB) while on oral anticoagulants. Using U.S. insurance claims data (2010–2017), researchers compared outcomes in patients who resumed anticoagulation within 90 days post-discharge—either with direct oral anticoagulants (DOACs, n=1,373) or warfarin (n=3,016). Outcomes included major bleeding, ischemic stroke/systemic embolism, all-cause mortality, and a composite net adverse clinical event (NACE).

Results: DOAC resumption was associated with a significantly lower risk of subsequent major bleeding (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.60–0.96) and NACE (HR, 0.83; 95% CI, 0.72–0.97) compared with warfarin. Stroke/systemic embolism rates were similar between groups (HR, 0.91; 95% CI, 0.53–1.55).

Clinical impact: For afib patients recovering from major GIB, restarting anticoagulation with DOACs offers a safer profile than warfarin, particularly regarding bleeding risk and overall adverse outcomes. These findings support guideline recommendations favoring DOACs in post-GIB anticoagulation strategies.

Source:

Lawal OD, et al. (2025, August 25). Pharmacotherapy. Restarting Oral Anticoagulation in Patients With Atrial Fibrillation After Admission for a Gastrointestinal Bleeding Event: Effectiveness and Safety of Direct Oral Anticoagulants Compared to Warfarin.https://pubmed.ncbi.nlm.nih.gov/40852894/