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Comparative differences in the risk of major gastrointestinal bleeding among different direct oral anticoagulants: An
Xiuehui Chen1, Lili Wang2, Huijun Li2
1Longhua District Central Hospital, Shenzhen, China.
Insights
Direct oral anticoagulants (DOACs) show varying gastrointestinal (GI) bleeding risks. Apixaban at standard doses and edoxaban at low doses appear to have the most favorable safety profiles for reducing major GI bleeding events.
Area of Science:
- Pharmacology
- Gastroenterology
- Clinical Trials
Background:
- Gastrointestinal (GI) bleeding risk varies among direct oral anticoagulants (DOACs), a topic of ongoing debate.
- This meta-analysis synthesizes recent data to compare the GI bleeding safety profiles of different DOACs.
Purpose of the Study:
- To conduct a meta-analysis comparing the risk of major GI bleeding across various direct oral anticoagulants (DOACs).
- To identify which DOACs, if any, present a more favorable GI safety profile.
Main Methods:
- Systematic search of PubMed, Cochrane library, and clinicaltrials.gov for relevant randomized controlled trials (RCTs).
- Inclusion of 37 RCTs evaluating DOAC safety, with major GI bleeding as the primary endpoint.
- Application of traditional and network meta-analysis techniques to compare bleeding risks.
Main Results:
- A significant difference in major GI bleeding risk was observed among various DOACs (p < .10).
- No DOACs demonstrated an increased risk of major GI bleeding compared to conventional therapies.
- Standard-dose apixaban showed a lower major GI bleeding risk than edoxaban (60mg), rivaroxaban (≥15mg), and dabigatran (300mg).
- Low-dose edoxaban (30mg) had a lower major GI bleeding risk than low-dose rivaroxaban (10mg).
Conclusions:
- Significant differences exist in the major GI bleeding risks associated with different DOACs.
- Standard-dose apixaban is linked to the lowest major GI bleeding risk among DOACs.
- Low-dose edoxaban offers a reduced major GI bleeding risk compared to low-dose rivaroxaban.
Abstract:
Background: The most favorable gastrointestinal (GI) bleeding safety profile among different types of direct oral anticoagulants (DOACs) remains controversial. This meta-analysis includes the latest studies and aims to compare GI bleeding risk associated with the use of various DOACs. Methods: PubMed, Cochrane library, and clinicaltrial.gov were searched. Randomized control trials (RCTs) evaluating the safety of DOACs were identified. The primary endpoint assessed was major GI bleeding. Results: A total of 37 RCTs were included in the analyses. Based on the traditional meta-analysis, the major GI bleeding risk was different among various DOACs (interactive p-value <.10). Network meta-analysis findings showed that no DOACs increased the risk of major GI bleeding compared with conventional therapy. Furthermore, a 10 mg daily administration of apixaban reduced the major GI bleeding risk more than daily doses of 60 mg edoxaban, ≥15 mg rivaroxaban, and 300 mg dabigatran etexilate. No difference was observed between daily doses of 300 mg dabigatran etexilate, 60 mg edoxaban, and ≥15 mg rivaroxaban. The major GI bleeding risk associated with 30 mg daily dose of edoxaban was lower than with 10 mg daily rivaroxaban, and no differences between daily 5 mg apixaban, 30 mg edoxaban, and 220 mg dabigatran etexilate were observed. Conclusion: Differences in the major GI bleeding risk were observed when various DOACs were compared. Among standard-dose DOACs, apixaban was associated with the lowest degree of major GI risk. Among low-dose DOACs, edoxaban was associated with a lower major GI bleeding risk than rivaroxaban.
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