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Gastrointestinal bleeding among oral anticoagulant users: a comprehensive 7-year retrospective review using Türkiye's
Nuray Yilmaz Çakmak1, Naim Ata2, Serdar Can Güven3
1Department of Internal Medicine Sciences, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkiye.
Insights
Direct-acting oral anticoagulants (DOACs) showed a higher gastrointestinal bleeding (GIB) risk than vitamin K antagonists (VKAs). Age and comorbidities influenced GIB, with significant anticoagulation discontinuation post-event.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Comparative risk of gastrointestinal bleeding (GIB) between direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) is debated.
- National health databases are crucial for evaluating real-world anticoagulant safety profiles.
Purpose of the Study:
- To compare the incidence of GIB among DOAC and VKA users.
- To identify risk factors for GIB and analyze postbleeding management strategies.
Main Methods:
- Retrospective analysis of 102,545 patients using the Turkish Ministry of Health's e-Nabız system (January 2017-July 2023).
- GIB events identified via ICD codes; analysis included comorbidities, prior medication, interventions, mortality, drug survival, and post-GIB changes.
Main Results:
- DOAC users were older with more comorbidities than VKA users, showing a higher GIB frequency.
- GIB-related mortality was 0.6% for DOACs vs. 0.4% for VKAs (p < 0.01).
- Approximately 50% of patients discontinued anticoagulation within 3 months post-GIB, highest with apixaban (61.9%); rivaroxaban had the highest retention rate (40.7%) if anticoagulation continued.
Conclusions:
- Nationwide data suggest higher GIB incidence with DOACs compared to VKAs, potentially linked to age and comorbidities.
- Mortality rates are consistent with prior research, but warrant further investigation.
- High rates of anticoagulation discontinuation post-GIB highlight concerns for ongoing management and necessitate cautious patient care.
Background/Aim:
The comparative risk of gastrointestinal bleeding (GIB) among users of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) is a topic of ongoing debate. This study leverages a comprehensive national health database to evaluate the incidence of GIB, associated risk factors, and postbleeding management strategies among anticoagulated patients.
Materials And Methods:
Utilizing the Turkish Ministry of Health's e-Nabız system, we conducted a retrospective analysis of patients treated with DOACs and warfarin from January 2017 to July 2023. GIB events were identified using ICD codes, and comorbidities, prior medication use, interventions, and mortality rates were analyzed. Drug survival and patterns of changes following GIB were also evaluated.
Results:
Among 102,545 patients with a GIB event during anticoagulant treatment, DOAC users were older with a higher prevalence of comorbidities, except for chronic obstructive lung disease, compared to VKA users. GIB-related mortality was 0.6% in the DOAC group and 0.4% in the VKA group at admission after the GIB (p < 0.01). In all drug groups, approximately half of the patients discontinued anticoagulation due to GIB after 3 months, the rate being highest with apixaban (61.9%). In patients who continued anticoagulation, the anticoagulant prior to GIB remained the most common agent in all groups, with rivaroxaban having the highest retention rate (40.7%).
Conclusion:
This nationwide study indicates a higher frequency of GIB in DOAC users versus VKA users, with age and comorbidities potentially contributing to this trend. Mortality rates were comparable to the previous literature but warrant further investigation. The significant rate of discontinuation following GIB raises concerns about ongoing anticoagulation management. These findings underscore the need for cautious case management.
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