Pharmacy Clinical Pearl of the Day: Direct Oral Anticoagulants and Bleeding Risk


When direct oral anticoagulants are taken, especially for the first time, patients may be at risk of bleeding.

Clinical Pearl of the Day: Direct oral anticoagulants (DOACs) and bleeding risk


  • dabigatran (Pradaxa)
  • rivaroxaban (Xarelto)
  • apixaban (Eliquis)
  • edoxaban (Savaysa)
  • betrixaban (Bevyxxa)

These agents are associated with a higher risk of gastrointestinal bleeding.


  • When DOACs are taken, especially for the first time, patients may be at risk of bleeding.
  • Bleeding symptoms may include:
    • Black or tarry stool
    • Bright red blood in vomit
    • Cramps in abdomen
    • Dizziness or faintness
    • Paleness
    • Shortness of breath

It is especially important that patients are educated on the bleeding risk when taking DOACs and, if they notice any, to refer back to their pharmacist or physician as soon as possible.


Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges | Journal of the American Heart Association (

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