David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Cangemi DJ et al. Am J Gastroenterol 2017 Feb 28.

Retrospective data show a fourfold lower risk for bleeding with DOACs.

Study results are mixed on the comparative risk for gastrointestinal bleeding (GIB) associated with use of non–vitamin K–dependent direct oral anticoagulants (DOACs) versus warfarin. In the current retrospective study, investigators at a U.S. Veterans Administration healthcare center compared hospitalization rates for GIB in 803 patients taking DOACs (dabigatran, rivaroxaban, or apixaban) and 6263 patients taking warfarin.

Results were as follows:

GIB incidence was four times higher in warfarin users (2.5% vs. 0.6%).

DOAC users were more likely to have a venous thrombosis or pulmonary embolus as their indication for anticoagulation and to have a lower comorbidity index (trends not statistically significant).

Sources of GIB in the five affected DOAC users were angioectasias (2 patients), hemorrhoids (2), and postpolypectomy bleeding (1). In warfarin users, identified sources were upper GIB (35%), lower GIB (27%), and small bowel bleeding (4%).

Warfarin users were more likely to receive blood transfusions (65% vs. 20% [only 1 patient taking DOACs]).

A nonsignificant trend toward longer hospital stays in warfarin users was observed (mean days, 7.7 vs. 3.8).

The 90-day mortality rate for GIB was 7.6% in warfarin users and 0 in DOAC users (difference not statistically significant).

The authors conclude that the risk for GIB is considerably lower with DOACs versus warfarin.

CITATION(S):

Cangemi DJ et al. A comparison of the rate of gastrointestinal bleeding in patients taking non-vitamin K antagonist oral anticoagulants or warfarin. Am J Gastroenterol 2017 Feb 28; [e-pub]. 

JWatch