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New Research on NOACs: Which has More Bleeding Risk―Which is Safer?

Do you take the anticoagulant, Xarelto? Or one of the newer NOACs? Which is safest? Which has the least GI bleeding?

NOACs Research Study Results

The New NOACs - anticoagulants graphic at

Which is safer?

A Mayo Clinic study indicated that the risk of gastrointestinal (GI) bleeding is higher for patients taking Xarelto than for other anticoagulants in its class.

The researchers compared the gastrointestinal (GI) safety profile of three rival oral anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban). All of the patients in the study had Atrial Fibrillation.

Bleeding occurrence: GI bleeding occurred more frequently in patients taking Xarelto compared to Pradaxa (approximately 20% increased risk), while Eliquis had the lowest GI bleeding risk.

Age factor: They also found that the risk of GI bleeds increased with age. In particular, patients over the age of 75 were at an increased risk.

Safety: Eliquis had the most favorable GI safety profile, even among very elderly patients, and Xarelto had the least favorable.

NOAC drug manufacturers: Xarelto (Bayer/Janssen Pharmaceuticals), Pradaxa (Boehringer Ingelheim) and Eliquis (Bristol-Myers Squibb).

Reminder: Oral Anticoagulants are High Risk Medications

Oral anticoagulants are not like taking vitamins. They are considered high risk medications. They work by causing or increasing bleeding and can potentially cause serious and uncontrolled bleeds. “For patients with atrial fibrillation, NOACs still pose a major bleeding risk,” according to Dr. Shang-Hung Chang and his colleagues at Chang Gung Memorial Hospital in Taiwan.

But they are certainly better than having an A-Fib stroke which can kill or severely disable. This study only examined GI bleeds. But oral anticoagulants can have other bad effects.

About Pradaxa (dabigatran)

Pradaxa graphic at

NOAC: Pradaxa from Boehringer Ingelheim

Pradaxa in its clinical trial had more GI bleeds and indigestion (dyspepsia) than warfarin. The Pradaxa fact sheet states “In addition to bleeding, Pradaxa can cause stomach upset or burning, and stomach pain.”

Research: Nearly two out of five people (35%) could not tolerate Pradaxa, which is a high rate of adverse reactions. Patients on Pradaxa 150mg had an increased incidence of gastrointestinal adverse reactions (35%/yr) compared to warfarin (24%/yr).

If you’re taking Pradaxa (dabigatran), watch out for indigestion, burning, stomach pain and weight loss. Based on the clinical trial data, there is a danger that dabigatran over time may cause long-term damage to the gastrointestinal system.

These statements don’t capture the actual human toll that Pradaxa can produce for some—burning throat, roiling intestines, diarrhea, burning anus, lasting intestinal damage, etc.

(Pradaxa has an FDA-approved reversal agent Praxbind.)

About Xarelto (rivaroxaban)

Xarelto graphic at

NOAC: Xarelto from Janssen Pharmaceuticals

Xarelto lawsuits: There are currently nearly 15,000 lawsuits in the U.S. against the maker of Xarelto (Janssen Pharmaceuticals) not just for GI bleeds but for other side effects such as brain and rectal bleeds.

Xarelto and the other new anticoagulants (NOACs) have not been around long enough to determine their long-term effects.

NOACs vs Warfarin: We do know that long-term use of warfarin risks hemorrhagic strokes and microbleeds which lead to dementia. (See Watchman Better Than Lifetime on Warfarin) Will Xarelto have similar long-term effects? We just don’t know, but intuitively one would expect so.

Safest: If you have to take one of the new oral anticoagulants, this study indicates that Eliquis is the safest for GI bleeds. (Both Eliquis and Xarelto now have the FDA-approved reversal agent Andexxa. But not all ERs may carry it.)

The Bottom Line: Eliquis Tested the Best

Eliquis graphic at

NOAC: Eliquis from Bristol-Myers Squibb

In clinical trials, Eliquis tested the best. (See my article, The new Anticoagulants (NOACs)). Other research indicates that Eliquis is safer than its competitors (See the FAQ: Eliquis Safer).

So, should you switch to Eliquis? This is a decision only you and your doctor can make. First, whether or not to be on an anticoagulant, and if so, which one. This is one of the most difficult decisions you and your doctor must make. Note: you should revisit your choice from time to time as you and your risk can change over time.

Resources for this article
Abraham, N. S. et al. Gastrointestinal Safety of Direct Oral Anticoagulants: a Large Population-based Study. Gastroenterology. January 26, 2017. DOI:

Beltz, Melissa. New study: Xarelto bleeding risk greater than competing blood thinners. Kake com. January 26, 2017. Schmidt National Law Group.

Chang SH et al. JAMA. 2017;doi:10.1001/jama.2017.13883. October 3, 2017

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