Wong JM, et al. - Given a favorable bleeding risk profile of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) but less certainty regarding the safety of individual DOACs vs warfarin for specific bleeding outcomes, researchers undertook this analysis with 423,450 patients suffering from AF between 2013 to 2015 in the NCDR PINNACLE national ambulatory registry matched to the Centers for Medicare and Medicaid Services database. They applied Cox proportional hazard models to estimate the link of OAC with bleeding. The occurrence of a major bleeding event was reported in 6.9% of patients. The occurrence of intracranial hemorrhage was reported in fewer patients in relation to the use of rivaroxaban, dabigatran, and apixaban, vs warfarin users. Rivaroxaban users exhibited a higher risk of major gastrointestinal bleed (GIB), a lower risk was noted in dabigatran and apixaban users. Findings revealed a superior safety of DOACs vs warfarin in AF patients, except with rivaroxaban and GIB. Experts also noted the attenuation of the relative safety benefits of DOACs by age ≥75 years.