Abstract
Direct oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban, and rivaroxaban),) are used in the management of patients with atrial fibrillation, ischemic heart disease, venous thromboembolism, and valvular heart disease. These drugs also increase the risk of gastrointestinal (GI) bleeding from luminal sources such as ulcers or diverticula and after endoscopic procedures.1-2 Rivaroxaban is a direct competitive inhibitor of factor Xa and limits thrombin generation in a dose dependent manner.6 Although no serious bleeding was reported in the endoscopic mucosal biopsy performed under rivaroxaban in the literature. in our case, hemorrhagic shock developed due to leakage in the biopsy area as a result of antrum biopsy performed under rivaroxaban.