{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:44:38Z","timestamp":1782701078221,"version":"3.54.5"},"reference-count":62,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: As population aging increases the prevalence of atrial fibrillation (AF), the use of direct oral anticoagulants (DOACs) has expanded for thromboembolism prevention. Although DOACs offer advantages over vitamin K antagonists (VKAs), gastrointestinal bleeding (GIB) remains the most common extracranial adverse event. Current guidelines address global bleeding risk but provide limited guidance on site-specific gastrointestinal risk assessment and prevention. This narrative review aims to summarize current evidence on the mechanisms, etiologies, and risk factors for DOAC-associated gastrointestinal bleeding and to propose a pragmatic, risk-based framework to support clinicians in individualized bleeding prevention. Methods: A narrative review of studies published between 2004 and 2025 was conducted, including randomized clinical trials, real-world evidence, meta-analyses, and major society guidelines. Evidence addressing DOAC safety profiles, gastrointestinal bleeding etiologies, patient-level risk factors, medication interactions, and preventive strategies was analyzed. Results: Gastrointestinal bleeding in patients treated with DOAC is strongly influenced by underlying gastrointestinal pathology, comorbid conditions, and concomitant medications. Established risk factors include prior gastrointestinal hemorrhage, Helicobacter pylori infection, gastrointestinal malignancy, diverticulosis, and angiodysplasia, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet therapy, or selective serotonin reuptake inhibitors (SSRIs). DOACs differ in gastrointestinal safety: apixaban consistently demonstrates the most favorable profile, whereas rivaroxaban and high-dose dabigatran show higher GIB rates. Preventive strategies such as H. pylori testing and eradication, proton pump inhibitor use in high-risk individuals, avoidance of NSAIDs and unnecessary antiplatelet therapy, and individualized DOAC selection may help reduce bleeding risk. Conclusions: Gastrointestinal bleeding risk in patients receiving DOAC therapy should be assessed using a site-specific and dynamic approach. A structured strategy integrating baseline risk evaluation, correction of modifiable factors, tailored anticoagulant selection, and risk-adapted follow-up may improve the safety of anticoagulation. The proposed framework may provide a pragmatic approach to individualized bleeding risk mitigation while preserving the benefits of DOAC therapy; however, prospective validation is required before its routine implementation can be recommended.<\/jats:p>","DOI":"10.3390\/clinpract16070120","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:54:42Z","timestamp":1782694482000},"page":"120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevention of Gastrointestinal Bleeding in Patients Receiving Direct Oral Anticoagulants: A Narrative Review and Practical Framework for Prescribers"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4887-8025","authenticated-orcid":false,"given":"Nicoleta","family":"Dubei","sequence":"first","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7925-3806","authenticated-orcid":false,"given":"Larisa","family":"Anghel","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2823-8232","authenticated-orcid":false,"given":"Laura-C\u0103t\u0103lina","family":"Benchea","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu Andy","family":"Sasc\u0103u","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Prisacariu","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea Ovanez","family":"Balasanian","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7687-8624","authenticated-orcid":false,"given":"Bogdan-Sorin","family":"Tudurachi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-7139","authenticated-orcid":false,"given":"Bianca-\u0218tefania","family":"Profire","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6439-4561","authenticated-orcid":false,"given":"Cristian","family":"St\u0103tescu","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700503 Ia\u0219i, Romania"},{"name":"Cardiology Department, Cardiovascular Diseases Institute \u201cProf. Dr. George I. M. Georgescu\u201d, Ia\u0219i 700503, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2746","DOI":"10.1093\/eurheartj\/eht280","article-title":"Projections on the Number of Individuals with Atrial Fibrillation in the European Union, from 2000 to 2060","volume":"34","author":"Krijthe","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban versus Warfarin in Patients with Atrial Fibrillation","volume":"365","author":"Granger","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran versus Warfarin in Patients with Atrial Fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban versus Warfarin in Patients with Atrial Fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the Efficacy and Safety of New Oral Anticoagulants with Warfarin in Patients with Atrial Fibrillation: A Meta-Analysis of Randomised Trials","volume":"383","author":"Ruff","year":"2014","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1160\/TH13-02-0150","article-title":"Gastrointestinal Bleeding with the New Oral Anticoagulants--Defining the Issues and the Management Strategies","volume":"110","author":"Desai","year":"2013","journal-title":"Thromb. Haemost."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e004517","DOI":"10.1161\/JAHA.116.004517","article-title":"Major Bleeding Complications and Persistence with Oral Anticoagulation in Non-Valvular Atrial Fibrillation: Contemporary Findings in Real-Life Danish Patients","volume":"6","author":"Lamberts","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1161\/CIRCULATIONAHA.110.973008","article-title":"Risk of Upper Gastrointestinal Bleeding with Low-Dose Acetylsalicylic Acid Alone and in Combination with Clopidogrel and Other Medications","volume":"123","author":"Lin","year":"2011","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"g4606","DOI":"10.1136\/bmj.g4606","article-title":"Predicting Risk of Upper Gastrointestinal Bleed and Intracranial Bleed with Anticoagulants: Cohort Study to Derive and Validate the QBleed Scores","volume":"349","author":"Coupland","year":"2014","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109352","DOI":"10.1016\/j.thromres.2025.109352","article-title":"All-Cause Mortality after Major Gastrointestinal Bleeding among Patients Receiving Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis","volume":"252","author":"Chornenki","year":"2025","journal-title":"Thromb. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.thromres.2021.10.022","article-title":"Risk Factors and One-Year Mortality in Patients with Direct Oral Anticoagulant-Associated Gastrointestinal Bleeding","volume":"208","author":"Verso","year":"2021","journal-title":"Thromb. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e70051","DOI":"10.1111\/fcp.70051","article-title":"Impact of Direct Oral Anticoagulant Uptake on Hospitalizations for Stroke\/Transient Ischemic Attack, Intracranial Hemorrhage, and Gastrointestinal Bleeding in Individuals with Atrial Fibrillation: A Population-Based Study","volume":"39","author":"Antoniou","year":"2025","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1053\/j.gastro.2013.02.041","article-title":"New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis","volume":"145","author":"Holster","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chen, X., Wang, L., Li, H., Huang, W., Zhao, L., and Guo, W. (2022). Comparative Differences in the Risk of Major Gastrointestinal Bleeding among Different Direct Oral Anticoagulants: An Updated Traditional and Bayesian Network Meta-Analysis. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.1049283"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"814","DOI":"10.5009\/gnl230406","article-title":"Real-World Risk of Gastrointestinal Bleeding for Direct Oral Anticoagulants and Warfarin Users: A Distributed Network Analysis Using a Common Data Model","volume":"18","author":"Cha","year":"2024","journal-title":"Gut Liver"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e003725","DOI":"10.1161\/JAHA.116.003725","article-title":"Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation","volume":"5","author":"Yao","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.amjcard.2021.11.021","article-title":"Meta-Analysis Comparing Apixaban Versus Rivaroxaban for Management of Patients with Nonvalvular Atrial Fibrillation","volume":"166","author":"Mamas","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.cgh.2022.06.033","article-title":"Warfarin Is Associated with Higher Rates of Upper But Not Lower Gastrointestinal Bleeding Compared with Direct Oral Anticoagulants: A Population-Based Propensity-Weighted Cohort Study","volume":"21","author":"Ingason","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.gie.2007.09.024","article-title":"An Evaluation of Endoscopic Indications and Findings Related to Nonvariceal Upper-GI Hemorrhage in a Large Multicenter Consortium","volume":"67","author":"Enestvedt","year":"2008","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_23","first-page":"CD003840","article-title":"Eradication Therapy for Peptic Ulcer Disease in Helicobacter pylori-Positive People","volume":"4","author":"Ford","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jcmgh.2016.12.001","article-title":"The Clinical Evidence Linking Helicobacter pylori to Gastric Cancer","volume":"3","author":"Moss","year":"2017","journal-title":"Cell. Mol. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/j.1365-2036.2005.02444.x","article-title":"Meta-Analysis: Role of Helicobacter pylori Eradication in the Prevention of Peptic Ulcer in NSAID Users","volume":"21","author":"Vergara","year":"2005","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.cgh.2018.03.013","article-title":"Houston Consensus Conference on Testing for Helicobacter pylori Infection in the United States","volume":"16","author":"Kao","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1136\/gutjnl-2022-327745","article-title":"Management of Helicobacter pylori Infection: The Maastricht VI\/Florence Consensus Report","volume":"71","author":"Malfertheiner","year":"2022","journal-title":"Gut"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1053\/j.gastro.2012.12.038","article-title":"Effects of Helicobacter pylori Infection on Long-Term Risk of Peptic Ulcer Bleeding in Low-Dose Aspirin Users","volume":"144","author":"Chan","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3892\/etm.2020.9335","article-title":"Reducing Upper Digestive Bleeding Risk in Patients Treated with Direct Oral Anticoagulants and Concomitant Infection with Helicobacter pylori","volume":"20","author":"Suceveanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e12990","DOI":"10.1111\/hel.12990","article-title":"Risk of Hospitalization for Upper Gastrointestinal Bleeding in Helicobacter pylori Eradicated Patients Newly Started on Warfarin or Direct Oral Anticoagulants: A Population-Based Cohort Study","volume":"28","author":"Jiang","year":"2023","journal-title":"Helicobacter"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1136\/gut.2005.080754","article-title":"Risk of Upper Gastrointestinal Ulcer Bleeding Associated with Selective Cyclo-Oxygenase-2 Inhibitors, Traditional Non-Aspirin Non-Steroidal Anti-Inflammatory Drugs, Aspirin and Combinations","volume":"55","author":"Lanas","year":"2006","journal-title":"Gut"},{"key":"ref_32","unstructured":"GBD 2021 Osteoarthritis Collaborators (2023). Global, Regional, and National Burden of Osteoarthritis, 1990\u20132020 and Projections to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol., 5, e508\u2013e522."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"72","DOI":"10.2174\/1871525713666150911112526","article-title":"Atrial Fibrillation: Epidemiology and Peculiarities in the Elderly","volume":"13","year":"2015","journal-title":"Cardiovasc. Hematol. Agents Med. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/eurheartj\/ehae736","article-title":"Bleeding Risk Using Non-Steroidal Anti-Inflammatory Drugs with Anticoagulants after Venous Thromboembolism: A Nationwide Danish Study","volume":"46","author":"Petersen","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"690","DOI":"10.7326\/M13-1581","article-title":"Relation of Nonsteroidal Anti-Inflammatory Drugs to Serious Bleeding and Thromboembolism Risk in Patients with Atrial Fibrillation Receiving Antithrombotic Therapy: A Nationwide Cohort Study","volume":"161","author":"Lamberts","year":"2014","journal-title":"Ann. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.amjmed.2022.05.031","article-title":"Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis","volume":"135","author":"Kurlander","year":"2022","journal-title":"Am. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Medhat, R.M., Kotb, O.A., and Baecker, D. (2026). Suzetrigine, a NaV1.8 Inhibitor as a Novel Approach for Pain Therapy-A Medicinal and Chemical Drug Profile. Molecules, 31.","DOI":"10.3390\/molecules31020358"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease Developed in Collaboration with EACTS: The Task Force for Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Giovannini, S., Onder, G., van der Roest, H.G., Topinkova, E., Gindin, J., Cipriani, M.C., Denkinger, M.D., Bernabei, R., Liperoti, R., and SHELTER Study Investigators (2020). Use of Antidepressant Medications among Older Adults in European Long-Term Care Facilities: A Cross-Sectional Analysis from the SHELTER Study. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01730-5"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.phrs.2016.08.017","article-title":"Bleeding Risk under Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants: A Meta-Analysis of Observational Studies","volume":"118","author":"Laporte","year":"2017","journal-title":"Pharmacol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"47","DOI":"10.31887\/DCNS.2007.9.1\/dhalperin","article-title":"Influence of Antidepressants on Hemostasis","volume":"9","author":"Halperin","year":"2007","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.psc.2016.04.010","article-title":"Serotonin Reuptake Inhibitors and Risk of Abnormal Bleeding","volume":"39","author":"Andrade","year":"2016","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000319744","article-title":"Antidepressants: Clinically Relevant Drug Interactions to Be Considered","volume":"86","author":"Schellander","year":"2010","journal-title":"Pharmacology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1503\/cmaj.100912","article-title":"Risk of Bleeding Associated with Combined Use of Selective Serotonin Reuptake Inhibitors and Antiplatelet Therapy Following Acute Myocardial Infarction","volume":"183","author":"Labos","year":"2011","journal-title":"CMAJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.cgh.2014.06.021","article-title":"Use of Selective Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis","volume":"13","author":"Jiang","year":"2015","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jviscsurg.2014.03.008","article-title":"The Management of Lower Gastrointestinal Bleeding","volume":"151","author":"Marion","year":"2014","journal-title":"J. Visc. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.cgh.2008.03.021","article-title":"Risk Factors for Mortality in Lower Intestinal Bleeding","volume":"6","author":"Strate","year":"2008","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Anghel, L., Sasc\u0103u, R., Trifan, A., Zota, I.M., and St\u0103tescu, C. (2020). Non-Vitamin K Antagonist Oral Anticoagulants and the Gastrointestinal Bleeding Risk in Real-World Studies. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051398"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11894-013-0333-5","article-title":"Lower GI Bleeding: Epidemiology and Management","volume":"15","author":"Ghassemi","year":"2013","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Aoki, N., Abe, K., Tokutomi, H., Kajita, K., Sone, M., Honda, T., Aoyagi, H., Isono, A., Konno, K., and Kozuma, K. (2024). Characteristics of Gastrointestinal Bleeding While Taking Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Differences Among Drugs-A Single-Center Retrospective Cohort Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010095"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4253\/wjge.v2.i5.147","article-title":"Lower Gastrointestinal Bleeding in the Elderly","volume":"2","author":"Chait","year":"2010","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s00384-013-1804-8","article-title":"Risk of Recurrence and Long-Term Outcomes after Colonic Diverticular Bleeding","volume":"29","author":"Aytac","year":"2014","journal-title":"Int. J. Color. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"10697","DOI":"10.3748\/wjg.v21.i37.10697","article-title":"Risk Factors for Adverse In-Hospital Outcomes in Acute Colonic Diverticular Hemorrhage","volume":"21","author":"Nagata","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1111\/jgh.12595","article-title":"Colonic Diverticular Hemorrhage Associated with the Use of Nonsteroidal Anti-Inflammatory Drugs, Low-Dose Aspirin, Antiplatelet Drugs, and Dual Therapy","volume":"29","author":"Nagata","year":"2014","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e8090","DOI":"10.1097\/MD.0000000000008090","article-title":"Analysis of Risk Factors for Colonic Diverticular Bleeding and Recurrence","volume":"96","author":"Taki","year":"2017","journal-title":"Medicine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/j.1440-1746.2010.06586.x","article-title":"Epidemiology of Lower Gastrointestinal Bleeding in China: Single-Center Series and Systematic Analysis of Chinese Literature with 53,951 Patients","volume":"26","author":"Bai","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MEG.0000000000002027","article-title":"Thirty-Day Readmission Rates, Reasons, and Costs for Gastrointestinal Angiodysplasia-Related Bleeding in the USA","volume":"34","author":"Khan","year":"2022","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e011848","DOI":"10.1161\/CIRCINTERVENTIONS.122.011848","article-title":"Reduction of Gastrointestinal Bleeding in Patients with Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation","volume":"15","author":"Goltstein","year":"2022","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e2442324","DOI":"10.1001\/jamanetworkopen.2024.42324","article-title":"Gastrointestinal Angiodysplasia Resolution After Transcatheter Aortic Valve Implantation","volume":"7","author":"Goltstein","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1161\/CIRCULATIONAHA.124.070865","article-title":"Bleeding and New Malignancy Diagnoses After Anticoagulation for Atrial Fibrillation: A Population-Based Cohort Study","volume":"151","author":"Grewal","year":"2025","journal-title":"Circulation"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1080\/17425255.2023.2287472","article-title":"Pharmacokinetics and Pharmacodynamics of Direct Oral Anticoagulants","volume":"19","author":"Hindley","year":"2023","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1053\/j.gastro.2021.12.247","article-title":"AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review","volume":"162","author":"Targownik","year":"2022","journal-title":"Gastroenterology"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/7\/120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T01:54:19Z","timestamp":1782698059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/7\/120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":62,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["clinpract16070120"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16070120","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}