LAUSR

BACKGROUND AND AIMS There is an increasing number of patients undergoing gastrointestinal endoscopic procedures with active prescriptions for direct oral anticoagulants (DOACs). DOACs have been associated with a higher risk of gastrointestinal bleeding (GIB) compared with warfarin. Our aims were to compare the risk of postendoscopic gastrointestinal bleeding (GIB) and thromboembolic (TE) events among patients on DOACs versus warfarin. METHODS We conducted a retrospective cohort study of patients age 18 years or older in a large integrated healthcare system in Southern California, who had undergone an outpatient gastrointestinal (GI) endoscopic procedure and were taking a DOAC or warfarin between January 1, 2013 and October 1, 2019. We compared bleeding and thrombosis risk in the 30 days after the endoscopic procedure between the warfarin and DOAC groups using multivariate logistic regression analysis adjusted for covariates. RESULTS Between January 1, 2013 and October 1, 2019, we identified 6765 outpatient GI endoscopic procedures in which patients received pre-procedure prescriptions for either a DOAC (1587) or warfarin (5178). Overall, there was no significant difference in postprocedure GIB (OR, 1.165; 95% CI, 0.88 - 1.55; p = 0.291) or TE (OR, 0.929; 95% CI, 0.64 - 1.35; p = 0.703) between the DOAC and warfarin groups). Subgroup analysis revealed a higher risk of GIB associated with DOAC specifically in esophagogastroduodenoscopy (EGD) procedures (OR, 1.8; 95% CI, 1.15 - 2.83; p = 0.011). CONCLUSIONS There was no significant difference in the overall postendoscopic risk of GIB and TE events among patients with preprocedure use of DOACs compared with patients on warfarin. There may be a higher risk of GIB in patients taking DOAC and undergoing EGD.