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Do All DOACs Confer Similar GI Bleeding Risk?
Observational studies suggest that rivaroxaban might confer higher risk for gastrointestinal (GI) bleeding than do other direct-acting oral anticoagulants (DOACs). Investigators used Iceland's nationwide prescription and electronic medical record databases to compare rates of GI bleeding among ≈5800 new users of apixaban, dabigatran, and rivaroxaban (55%, 37%, and 8% of cohort, respectively). Patients were followed for a mean 1.5 years; all diagnoses of GI bleeding were verified by medical record review. Patients with end-stage renal disease were excluded.
In propensity-score–matched analysis, patients who received rivaroxaban had significantly higher rates of GI bleeding (3.2% vs. 2.5% annually) and major GI bleeding (1.9% vs. 1.4% annually) than did apixaban recipients. Rivaroxaban users also seemed to have higher bleeding rates than dabigatran users, but results did not reach statistical significance.
Comment
This study adds to a growing body of evidence about differential adverse effects among various agents within the DOAC drug class. This nationwide evaluation was strengthened by its broad search and verification of each bleeding event. When patients require initiation of long-term management with a DOAC, I'll certainly continue to inform them that the bleeding risk might not be completely equal between agents.
Citation(s)
Author:
Ingason AB et al.
Title:
Rivaroxaban is associated with higher rates of gastrointestinal bleeding than other direct oral anticoagulants: A nationwide propensity score–weighted study.
Source:
Ann Intern Med
2021
Oct
12; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Daniel D. Dressler, MD, MSc, MHM, FACP