SP 2.08 Outcomes of Lower Gastrointestinal Bleeding in Patients on Direct Oral Anticoagulants: A Single-Centre Retrospective Cohort Study

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ID: 324091
2026
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Abstract
Abstract Aims Direct oral anticoagulants (DOACs) are widely prescribed and are associated with gastrointestinal bleeding. Current data describing investigation, transfusion requirements, anticoagulant management and recurrence after DOAC-associated lower gastrointestinal bleeding (LGIB) remains limited. Methods We performed a single-centre retrospective cohort study at a district general hospital from 2018 to 2026. Patients were included if admitted with LGIB while prescribed a DOAC. Outcomes included red cell transfusion, inpatient investigation, transfer for embolisation, anticoagulant interruption, length of stay and recurrent LGIB admissions. Results 99 patients were included with a median age of 82 years and a mean Charlson Comorbidity index of 5.8. The recorded DOAC’s were edoxaban in 49.5%, apixaban in 43.4% and rivaroxaban in 7.1%. Median length of stay was 4 days (IQR 3–6.3). Transfusion was given in 26.3% patients, with a median of 2 units per patient. Endoscopy was performed in 27.3% patients, with inpatient being 16.2%, and outpatient being 17.2% of total patients. CT angiography was performed in 10.1%, only 1 patient required transfer for embolisation. DOAC therapy was paused in admission in all cases, and the median hold duration was 5 days (IQR 3–9). Restart by discharge was documented in 57.6% and discontinuation in 15.2%. Recurrent LGIB admission was recorded in 56.6% of patients. Conclusions DOAC-associated LGIB predominantly affected older patients, with substantial transfusion and high recurrence. Investigation and anticoagulant management varied, highlighting the need for structured short-term and long term management pathways. Reassuringly, in hospital outcomes of DOAC associated LGIB nearly always settled with conservative measures.
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Authors R. T. Seal, Joyanto Biswas, Kanapathi Rajaratnam, Max Wilde, Fanos Georgiades, Yogeshkumar Malam
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Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.027
URL
https://doi.org/10.1093/bjs/znag087.027
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