Mortality after major bleeding in Asian atrial fibrillation patients receiving different direct oral anticoagulants:...

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Atrial fibrillation (AF) management often involves anticoagulation.
• Direct oral anticoagulants (DOACs) are widely prescribed for AF.
• Major bleeding events are a significant complication in patients on anticoagulation therapy.

Purpose of the Study:

• To assess and compare 7-day and 30-day mortality rates following major bleeding events in atrial fibrillation patients treated with different DOACs.
• To identify potential differences in mortality risk among various DOACs after major bleeding episodes.

Main Methods:

• Retrospective cohort study using the Taiwan National Health Insurance Research Database (2016-2019).
• Inclusion of atrial fibrillation patients experiencing major bleeding while on dabigatran, rivaroxaban, apixaban, or edoxaban.
• Application of propensity score stabilized weighting to create comparable pseudo-DOAC groups for analysis.

Main Results:

• A total of 2770 patients were analyzed, with 85.3% on low-dose regimens.
• The 7-day mortality rate was 9.0%, increasing to 16.0% by day 30.
• Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) showed significantly higher 7-day mortality risk compared to dabigatran (p=0.012).

Conclusions:

• Factor Xa inhibitors are associated with a higher risk of 7-day mortality post-major bleeding compared to dabigatran in AF patients.
• This finding was consistent even in the subgroup receiving lower-dose DOACs.
• Clinical vigilance and further research are warranted regarding DOAC selection post-bleeding events.