{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:28:34Z","timestamp":1786361314755,"version":"build-2736575974"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,10]]},"DOI":"10.7759\/cureus.114253","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:37:02Z","timestamp":1786358222000},"source":"Crossref","is-referenced-by-count":0,"title":["Resumption of Direct Oral Anticoagulants After Gastrointestinal Bleeding in Atrial Fibrillation: A Systematic Review of Timing and Clinical Outcomes"],"prefix":"10.7759","author":[{"given":"Bader","family":"Jad Allah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Haider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabah Shakeel","family":"Shaikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyan","family":"Botsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Quadir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshna","family":"Devi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"Lippi G","year":"2021","unstructured":"Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021, 16:217-21. 10.1177\/1747493019897870","journal-title":"Int J Stroke"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: the Framingham Study","volume":"22","author":"Wolf PA","year":"1991","unstructured":"Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991, 22:983-8. 10.1161\/01.str.22.8.983","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1159\/000068743","article-title":"Atrial fibrillation is associated with severe acute ischemic stroke","volume":"22","author":"Dulli DA","year":"2003","unstructured":"Dulli DA, Stanko H, Levine RL. Atrial fibrillation is associated with severe acute ischemic stroke. Neuroepidemiology. 2003, 22:118-23. 10.1159\/000068743","journal-title":"Neuroepidemiology"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24086879","article-title":"Challenges of anticoagulant therapy in atrial fibrillation-focus on gastrointestinal bleeding","volume":"24","author":"Scridon A","year":"2023","unstructured":"Scridon A, Balan AI. Challenges of anticoagulant therapy in atrial fibrillation-focus on gastrointestinal bleeding. Int J Mol Sci. 2023, 24:10.3390\/ijms24086879","journal-title":"Int J Mol Sci"},{"key":"ref5","doi-asserted-by":"publisher","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 randomized trials","volume":"383","author":"Ruff CT","year":"2013","unstructured":"Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomized trials. Lancet. 2013, 383:955-62. 10.1016\/S0140-6736(13)62343-0","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.5114\/aoms\/192240","article-title":"Resumption versus discontinuation of direct oral anticoagulation after an episode of gastrointestinal bleeding: a systematic review and meta-analysis of rebleeding episodes","volume":"21","author":"Morarasu BC","year":"2025","unstructured":"Morarasu BC, Sorodoc L, Morarasu S, et al.. Resumption versus discontinuation of direct oral anticoagulation after an episode of gastrointestinal bleeding: a systematic review and meta-analysis of rebleeding episodes. Arch Med Sci. 2025, 21:1965-73. 10.5114\/aoms\/192240","journal-title":"Arch Med Sci"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001796","article-title":"Safety of direct oral anticoagulants for gastrointestinal hemorrhage in patients with nonvalvular atrial fibrillation: a systematic review and meta-analysis of real-world studies","volume":"57","author":"Archontakis Barakakis P","year":"2023","unstructured":"Archontakis Barakakis P, Kokkinidis DG, Li W, et al.. Safety of direct oral anticoagulants for gastrointestinal hemorrhage in patients with nonvalvular atrial fibrillation: a systematic review and meta-analysis of real-world studies. J Clin Gastroenterol. 2023, 57:1045-53. 10.1097\/MCG.0000000000001796","journal-title":"J Clin Gastroenterol"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.7326\/M22-0511","article-title":"Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: a multinational population-based cohort study","volume":"175","author":"Lau WC","year":"2022","unstructured":"Lau WC, Torre CO, Man KK, et al.. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: a multinational population-based cohort study. Ann Intern Med. 2022, 175:1515-24. 10.7326\/M22-0511","journal-title":"Ann Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15476","article-title":"Recurrent bleeding and thrombotic events after resumption of oral anticoagulants following gastrointestinal bleeding: communication from the ISTH SSC Subcommittee on Control of Anticoagulation","volume":"19","author":"Candeloro M","year":"2021","unstructured":"Candeloro M, van Es N, Cantor N, et al.. Recurrent bleeding and thrombotic events after resumption of oral anticoagulants following gastrointestinal bleeding: communication from the ISTH SSC Subcommittee on Control of Anticoagulation. J Thromb Haemost. 2021, 19:2618-28. 10.1111\/jth.15476","journal-title":"J Thromb Haemost"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-020-06248-9","article-title":"Resuming anticoagulation following hospitalization for gastrointestinal bleeding is associated with reduced thromboembolic events and improved mortality: results from a systematic review and meta-analysis","volume":"66","author":"Tapaskar N","year":"2021","unstructured":"Tapaskar N, Pang A, Werner DA, Sengupta N. Resuming anticoagulation following hospitalization for gastrointestinal bleeding is associated with reduced thromboembolic events and improved mortality: results from a systematic review and meta-analysis. Dig Dis Sci. 2021, 66:554-66. 10.1007\/s10620-020-06248-9","journal-title":"Dig Dis Sci"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.053","article-title":"2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Solution Set Oversight Committee","volume":"76","author":"Tomaselli GF","year":"2020","unstructured":"Tomaselli GF, Mahaffey KW, Cuker A, et al.. 2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020, 76:594-622. 10.1016\/j.jacc.2020.04.053","journal-title":"J Am Coll Cardiol"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar JA","year":"2024","unstructured":"Joglar JA, Chung MK, Armbruster AL, et al.. 2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024, 149:e1-156. 10.1161\/CIR.0000000000001193","journal-title":"Circulation"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021, 372:n71. 10.1136\/bmj.n71","journal-title":"BMJ"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.05.005","article-title":"Rebleeding vs thromboembolism after hospitalization for gastrointestinal bleeding in patients on direct oral anticoagulants","volume":"16","author":"Sengupta N","year":"2018","unstructured":"Sengupta N, Marshall AL, Jones BA, Ham S, Tapper EB. Rebleeding vs thromboembolism after hospitalization for gastrointestinal bleeding in patients on direct oral anticoagulants. Clin Gastroenterol Hepatol. 2018, 16:1893-900.e2. 10.1016\/j.cgh.2018.05.005","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1177\/1060028020912429","article-title":"Outcomes associated with resuming direct oral anticoagulant therapy following admission for a gastrointestinal bleed","volume":"54","author":"Valanejad SM","year":"2020","unstructured":"Valanejad SM, Davis KA, Nisly SA. Outcomes associated with resuming direct oral anticoagulant therapy following admission for a gastrointestinal bleed. Ann Pharmacother. 2020, 54:975-80. 10.1177\/1060028020912429","journal-title":"Ann Pharmacother"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31820f14c0","article-title":"2011 ACCF\/AHA\/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"123","author":"Wann LS","year":"2011","unstructured":"Wann LS, Curtis AB, Ellenbogen KA, et al.. 2011 ACCF\/AHA\/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines. Circulation. 2011, 123:1144-50. 10.1161\/CIR.0b013e31820f14c0","journal-title":"Circulation"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani M","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016, 5:210. 10.1186\/s13643-016-0384-4","journal-title":"Syst Rev"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea BJ","year":"2017","unstructured":"Shea BJ, Reeves BC, Wells G, et al.. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017, 358:j4008. 10.1136\/bmj.j4008","journal-title":"BMJ"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC, et al.. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016, 355:i4919. 10.1136\/bmj.i4919","journal-title":"BMJ"},{"key":"ref20","article-title":"Systematic Reviews of Etiology and Risk","author":"Moola S","year":"2020","unstructured":"Moola S, Munn Z, Tufanaru C, et al.. Systematic Reviews of Etiology and Risk. JBI Reviewer\u2019s Manual. Aromataris E, Munn Z (ed): JBI, 2020. 219-71."},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-022-03300-7","article-title":"Direct oral anticoagulants versus warfarin in nonvalvular atrial fibrillation patients with prior gastrointestinal bleeding: a network meta-analysis of real-world data","volume":"78","author":"Hu W","year":"2022","unstructured":"Hu W, Cai H, Zhang J. Direct oral anticoagulants versus warfarin in nonvalvular atrial fibrillation patients with prior gastrointestinal bleeding: a network meta-analysis of real-world data. Eur J Clin Pharmacol. 2022, 78:1057-67. 10.1007\/s00228-022-03300-7","journal-title":"Eur J Clin Pharmacol"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1093\/postmj\/qgaf090","article-title":"Risk of gastrointestinal rebleeding in direct oral anticoagulant-treated population","volume":"101","author":"Morarasu BC","year":"2025","unstructured":"Morarasu BC, Sorodoc V, Simiras C, et al.. Risk of gastrointestinal rebleeding in direct oral anticoagulant-treated population. Postgrad Med J. 2025, 101:1361-9. 10.1093\/postmj\/qgaf090","journal-title":"Postgrad Med J"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.131369","article-title":"Ischemic stroke and major bleeding while on direct oral anticoagulants in na\u00efve patients with atrial fibrillation: Impact of resumption or discontinuation of anticoagulant treatment. A population-based study","volume":"394","author":"Gennaro N","year":"2024","unstructured":"Gennaro N, Ferroni E, Zorzi M, Denas G, Pengo V. Ischemic stroke and major bleeding while on direct oral anticoagulants in na\u00efve patients with atrial fibrillation: Impact of resumption or discontinuation of anticoagulant treatment. A population-based study. Int J Cardiol. 2024, 394:131369. 10.1016\/j.ijcard.2023.131369","journal-title":"Int J Cardiol"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.201433","article-title":"Rates of rebleeding, thrombosis and mortality associated with resumption of anticoagulant therapy after anticoagulant-related bleeding","volume":"193","author":"Little DH","year":"2021","unstructured":"Little DH, Sutradhar R, Cerasuolo JO, et al.. Rates of rebleeding, thrombosis and mortality associated with resumption of anticoagulant therapy after anticoagulant-related bleeding. CMAJ. 2021, 193:E304-9. 10.1503\/cmaj.201433","journal-title":"CMAJ"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260585","article-title":"Thrombotic events and rebleeding after hemorrhage in patients taking direct oral anticoagulants for non-valvular atrial fibrillation","volume":"16","author":"Yanagisawa D","year":"2021","unstructured":"Yanagisawa D, Abe K, Amano H, et al.. Thrombotic events and rebleeding after hemorrhage in patients taking direct oral anticoagulants for non-valvular atrial fibrillation. PLoS One. 2021, 16:e0260585. 10.1371\/journal.pone.0260585","journal-title":"PLoS One"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1177\/2050313X17753336","article-title":"Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab","volume":"6","author":"Riario Sforza GG","year":"2018","unstructured":"Riario Sforza GG, Gentile F, Stock F, Caggiano F, Chiocca E, Incorvaia C. Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab. SAGE Open Med Case Rep. 2018, 6:2050313X17753336. 10.1177\/2050313X17753336","journal-title":"SAGE Open Med Case Rep"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness LA","year":"2021","unstructured":"McGuinness LA, Higgins JP. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021, 12:55-61. 10.1002\/jrsm.1411","journal-title":"Res Synth Methods"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvy272","article-title":"The prothrombotic state in atrial fibrillation: pathophysiological and management implications","volume":"115","author":"Khan AA","year":"2019","unstructured":"Khan AA, Lip GY. The prothrombotic state in atrial fibrillation: pathophysiological and management implications. Cardiovasc Res. 2019, 115:31-45. 10.1093\/cvr\/cvy272","journal-title":"Cardiovasc Res"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1177\/1756283X17702092","article-title":"Direct oral anticoagulants and digestive bleeding: therapeutic management and preventive measures","volume":"10","author":"Deutsch D","year":"2017","unstructured":"Deutsch D, Bousti\u00e8re C, Ferrari E, Albaladejo P, Morange PE, Benamouzig R. Direct oral anticoagulants and digestive bleeding: therapeutic management and preventive measures. Ther Adv Gastroenterol. 2017, 10:495-505. 10.1177\/1756283X17702092","journal-title":"Ther Adv Gastroenterol"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.3189","article-title":"Resuming anticoagulation following upper gastrointestinal bleeding among patients with nonvalvular atrial fibrillation\u2014a microsimulation analysis","volume":"14","author":"Pappas MA","year":"2019","unstructured":"Pappas MA, Evans N, Rizk MK, Rothberg MB. Resuming anticoagulation following upper gastrointestinal bleeding among patients with nonvalvular atrial fibrillation\u2014a microsimulation analysis. J Hosp Med. 2019, 14:394-400. 10.12788\/jhm.3189","journal-title":"J Hosp Med"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder IC","year":"2024","unstructured":"Van Gelder IC, Rienstra M, Bunting KV, et al.. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024, 45:3314-414. 10.1093\/eurheartj\/ehae176","journal-title":"Eur Heart J"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.3390\/ijms232213955","article-title":"Gastrointestinal bleeding due to NOACs use: Exploring the molecular mechanisms","volume":"23","author":"Saviano A","year":"2022","unstructured":"Saviano A, Brigida M, Petruzziello C, Candelli M, Gabrielli M, Ojetti V. Gastrointestinal bleeding due to NOACs use: Exploring the molecular mechanisms. Int J Mol Sci. 2022, 23:10.3390\/ijms232213955","journal-title":"Int J Mol Sci"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.1049283","article-title":"Comparative differences in the risk of major gastrointestinal bleeding among different direct oral anticoagulants: an updated traditional and Bayesian network meta-analysis","volume":"13","author":"Chen X","year":"2022","unstructured":"Chen X, Wang L, Li H, Huang W, Zhao L, Guo W. Comparative differences in the risk of major gastrointestinal bleeding among different direct oral anticoagulants: an updated traditional and Bayesian network meta-analysis. Front Pharmacol. 2022, 13:1049283. 10.3389\/fphar.2022.1049283","journal-title":"Front Pharmacol"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab065","article-title":"2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"23","author":"Steffel J","year":"2021","unstructured":"Steffel J, Collins R, Antz M, et al.. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace. 2021, 23:1612-76. 10.1093\/europace\/euab065","journal-title":"Europace"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814051","article-title":"Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors","volume":"380","author":"Connolly SJ","year":"2019","unstructured":"Connolly SJ, Crowther M, Eikelboom JW, et al.. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019, 380:1326-35. 10.1056\/NEJMoa1814051","journal-title":"N Engl J Med"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1002\/phar.70055","article-title":"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","volume":"45","author":"Lawal OD","year":"2025","unstructured":"Lawal OD, Aronow HD, Shobayo F, et al.. 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. Pharmacotherapy. 2025, 45:638-53. 10.1002\/phar.70055","journal-title":"Pharmacotherapy"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/520781-resumption-of-direct-oral-anticoagulants-after-gastrointestinal-bleeding-in-atrial-fibrillation-a-systematic-review-of-timing-and-clinical-outcomes","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:37:03Z","timestamp":1786358223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/520781-resumption-of-direct-oral-anticoagulants-after-gastrointestinal-bleeding-in-atrial-fibrillation-a-systematic-review-of-timing-and-clinical-outcomes"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":36,"URL":"https:\/\/doi.org\/10.7759\/cureus.114253","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}