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Cohort study
Apixaban may have lower risk of GI bleeding compared with dabigatran and rivaroxaban in patients with atrial fibrillation
  1. José Miguel Rivera-Caravaca1,2,
  2. Gregory Y H Lip1,3
  1. 1 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  2. 2 Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
  3. 3 Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Professor Gregory Y H Lip, University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK; g.y.h.lip{at}

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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 …

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  • Funding JMR-C is supported by Instituto Murciano de Investigación Biosanitaria (IMIB16/AP/01/06) and has received a grant from Sociedad Española de Trombosis y Hemostasia (grant for short international training stays 2016).

  • Competing interests GYHL is a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife and Daiichi Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi Sankyo. No fees are received personally.

  • Provenance and peer review Commissioned; internally peer reviewed.