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Risk of gastrointestinal bleeding with dabigatran: a head-to-head comparative study with rivaroxaban

Muhammed Sherid1, Humberto Sifuentes, Samian Sulaiman

  • 1Section of Gastroenterology and Hepatology, Georgia Regents University, Augusta, Ga., USA.

Digestion
|October 4, 2014
PubMed

Insights

Gastrointestinal bleeding risk with dabigatran and rivaroxaban is similar, with both showing increased risk in the first 40 days of use. Concomitant dual antiplatelet use with rivaroxaban increased bleeding risk.

Area of Science:

  • Pharmacology
  • Gastroenterology
  • Clinical Medicine

Background:

  • Gastrointestinal (GI) bleeding risk associated with direct oral anticoagulants (DOACs) like dabigatran and rivaroxaban requires further investigation.
  • Comparative data on GI bleeding incidence between dabigatran and rivaroxaban is limited.

Purpose of the Study:

  • To compare the risk of gastrointestinal bleeding between patients taking dabigatran and those taking rivaroxaban.
  • To identify factors associated with increased GI bleeding risk in patients on these DOACs.

Main Methods:

  • Retrospective analysis of medical records from October 2010 to April 2013.
  • Inclusion of 374 patients on either dabigatran or rivaroxaban from two hospitals.
  • Multivariate analysis to assess bleeding risk factors.

Main Results:

  • Overall GI bleeding incidence was similar between dabigatran (5.3%) and rivaroxaban (4.8%).
  • Both dabigatran and rivaroxaban showed a higher bleeding risk within the first 40 days of treatment.
  • Dual antiplatelet therapy with rivaroxaban and prior GI bleeding were associated with significantly increased bleeding risk.

Conclusions:

  • Dabigatran is not associated with a higher incidence of GI bleeding compared to rivaroxaban.
  • The initial 40 days of treatment with either dabigatran or rivaroxaban pose a heightened risk for GI bleeding.
  • Risk stratification for rivaroxaban should consider concomitant dual antiplatelet use and history of GI bleeding.
Abstract

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