Compared with apixaban, which direct oral anticoagulant has a higher risk of GI bleeding in older adults when used long-term for nonvalvular AF or VTE?

• A. Warfarin
• B. Apixaban
• C. Dabigatran
• D. Rivaroxaban

Answer: (C)

In older adults, the risk of GI bleeding varies across direct oral anticoagulants, and dabigatran tends to have the highest GI bleeding risk among them when used long-term for nonvalvular AF or VTE compared with apixaban. Dabigatran is mostly cleared by the kidneys, so reduced renal function in older patients leads to higher drug exposure and a greater chance of bleeding, including in the GI tract. Trials and analyses consistently show higher GI bleeding with dabigatran, especially at the 150 mg dose, relative to apixaban, while apixaban generally has one of the lower GI bleeding risk profiles among DOACs. Therefore, dabigatran is the DOAC most associated with higher GI bleeding risk when compared with apixaban in this older population.