Direct Oral Anticoagulants, COX-2–Selective NSAIDs, and Gastrointestinal Bleeding in Atrial Fibrillation

Is there a difference in the risk of gastrointestinal (GI) bleeding between cyclooxygenase 2 (COX-2)–selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) among patients treated with direct oral anticoagulants (DOACs)?In this cohort study of 30 240 patients with nonvalvular atrial fibrillation, concomitant use of DOACs and COX-2–selective NSAIDs was associated with a statistically significant 37% decrease in the risk of GI bleeding vs concomitant use of DOACs and nonselective NSAIDs.These findings suggest that COX-2–selective NSAIDs may retain their beneficial effects regarding GI bleeding during concomitant use with DOACs.

Corresponding Author: Antonios Douros, MD, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany (antonios.douros@charite.de).

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