Gastrointestinal bleeding during treatment with non -vitamin K antagonist oral anticoagulants (NOACs) may be caused by malignant lesions Gastrointestinal bleeding due to underlying malignancy may not be uncommon in real life patients on non vitamin K antagonist oral anticoagulants (NOACs) like dabigatran, rivaroxaban or apixaban. We performed a small pilot study in patients referred to endoscopy due to suspected gastrointestinal bleeding. In twenty NOAC-treated patients, we found four cases of manifest malignant colon tumors, one premalignant colon adenoma, and one gastric B-cell lymphoma. All lesions were previously unknown and non-symptomatic apart from suspected gastrointestinal bleeding. Endoscopy should be performed in patients on NOACs with signs or suspicions of gastrointestinal bleeding. Whether a fecal occult blood test should be incorporated in the follow-up of patients on NOAC treatment deserves to be investigated in future studies.
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