Proceedings of the 13th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2026
Vol. 5 No. s1 (2026)
Mortality following major gastrointestinal bleeding among patients receiving direct oral anticoagulants
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 16 April 2026
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Direct oral anticoagulants (DOACs) are increasingly used for the treatment of cancer-associated venous thromboembolism (CAT). However, concerns remain regarding bleeding complications, particularly gastrointestinal (GI) bleeding, and their associated morbidity and mortality in patients with cancer. This narrative review summarizes available evidence on the epidemiology, predictors, mortality, and management of DOAC-associated major GI bleeding in this high-risk population. Across randomized controlled trials, major bleeding rates with DOACs range from 4 to 7%, with GI bleeding accounting for much of the observed excess bleeding, compared with low molecular weight heparin (LMWH), particularly among patients with unresected upper GI cancers. Observational studies in the cancer population confirm that GI bleeding is the predominant site of major bleeding complications, and it is associated with substantial 30-day mortality rates of 10-20%. Evidence to guide anticoagulation resumption after GI bleeding in patients with cancer is limited. Available data suggest that resumption of anticoagulation reduces thromboembolic events and all-cause mortality at the cost of increased recurrent bleeding risk, with early resumption associated with the highest rates of rebleeding events. In conclusion, GI bleeding is a frequent and clinically important complication of DOAC therapy in patients with cancer, highlighting the importance of individualized, multidisciplinary, and patient-centered management strategies.
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How to Cite
1.
Sharobim J, Wang T-F, Carrier M. Mortality following major gastrointestinal bleeding among patients receiving direct oral anticoagulants. Bleeding Thromb Vasc Biol [Internet]. 2026 Apr. 16 [cited 2026 Oct. 18];5(s1). Available from: https://www.btvb.org/btvb/article/view/432
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