Apixaban may have lower risk of GI bleeding compared with dabigatran and rivaroxaban in patients with atrial fibrillation.

Commentary on: Abraham NS, Noseworthy PA, Yao X, et al . Gastrointestinal safety of direct oral anticoagulants: a large population-based study. Gastroenterology 2017;152:1014–1022.e1. Oral anticoagulation (OAC) reduces the risk of stroke and mortality in atrial fibrillation (AF). The known limitations of vitamin K antagonists (VKAs) have led to the development of non-vitamin K oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban. These anticoagulants are at least as effective as VKAs for prevention of stroke in patients with AF and safer in terms of serious bleeding events.1–3 Given that high rates of gastrointestinal (GI) bleeding have been observed in NOACs,1 Abraham et al report a ‘real world’ study of the GI safety profile comparing the various NOACs head-to-head. Abraham et al enrolled both inpatients and outpatients with non-valvular AF who started dabigatran, apixaban or rivaroxaban during 1 October 2010 to 28 February 2015 from the Optum Labs Data …