First choice	For patients with a high risk of gastrointestinal bleeding, apixaban 5 mg twice daily or dabigatran 110 mg twice daily may be used
Second choice	Dabigatran 150 mg twice daily, edoxaban 60 mg once daily, or rivaroxaban 20 mg once daily
Comments	Gastrointestinal bleeding, even in the setting of anticoagulation, does usually not cause death or permanent major disability. Thus, the choice of OAC should be driven mainly by stroke prevention considerations. The label ‘high risk of gastrointestinal bleeding’ is imprecise. For example, patients with H. pylori-related ulcer haemorrhage may no longer be at high risk of bleeding once the infection has been eradicated. The gastrointestinal bleeding risk associated with any anticoagulant is increased by concurrent use of antiplatelet agents, including aspirin.41 As with warfarin, NOAC agents should be restarted as soon as deemed safe to do so once gastrointestinal bleeding has been controlled. The gastrointestinal bleeding risk of dabigatran and edoxaban are dose-dependent. The increased gastrointestinal bleeding risk of dabigatran and rivaroxaban are most evident in patients ≥75 years old. Gastrointestinal tract cancer screening and surveillance strategies (e.g. colonoscopy) increase early detection of occult tumours and may thereby reduce the incidence of neoplasm-associated gastrointestinal bleeding in patients receiving OACs.42 Age-appropriate colorectal cancer screening should be undertaken prior to initiation of OAC43