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Non–vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for various clinical indications. Some evidence shows that, like vitamin K antagonists and antiplatelet agents, NOACs are associated with an increased risk for gastrointestinal bleeding, but the differences in risk between NOACs and other anticoagulants is unknown.
In a meta-analysis of findings from 23 phase III, randomized, controlled trials, investigators compared the risk for major gastrointestinal bleeding (GIB) with use of NOACs, vitamin K antagonists, low-molecular-weight heparin, aspirin, or placebo in patients with atrial fibrillation or venous thromboembolism or patients undergoing major orthopedic surgery. Results were as follows:
Risk for major bleeding was…