Introduction:
Background. Direct oral anticoagulants (DOACs) have become standard of care in long term anticoagulation. Extensive research has focused on this new class of drugs that despite their benefits, have an associated risk of bleeding with lack of evidence for management following an episode of gastrointestinal bleeding (GIB). Our meta-analysis and systematic review provide an updated perspective on the rate of rebleeding in patients with an episode of GIB while on DOACs.

Material and methods:
Materials and methods. A systematic search of PubMed, EMBASE and Cochrane databases was performed for all comparative studies examining outcomes in patients that resumed versus withheld DOACs after a baseline episode of GIB. The initial search found 1823 studies. After excluding duplicates and unrelated studies based on abstract triage, 29 full texts were assessed for eligibility, out of which five matched the inclusion criteria and were systematically reviewed.

Results:
Results. Five studies containing data comparing clinical outcomes between patients were included. All studies were retrospective including a total of 2837 patients with a case control design. Both groups showed similar rebleeding rates with lower GIB as the primary site of rebleeding. Type of DOAC, timing of anticoagulation resumption and patients characteristics may influence rebleeding rates.

Conclusions:
Conclusions: Looking at the overall risk/benefit ratio of anticoagulation post GIB, we suggest there is a benefit for oral anticoagulation continuation. Further large scale studies are needed to provide optimal management strategies in this population.