Risk of Complicated Upper Gastrointestinal Bleeding With Direct Oral Anticoagulants: An Asian Population-Based...

Area of Science:

• Pharmacology
• Gastroenterology
• Clinical Research

Background:

• Limited Asian data exists on complicated upper gastrointestinal bleeding (UGIB) risks associated with direct oral anticoagulants (DOACs).
• Understanding these risks is crucial for optimizing anticoagulant therapy in diverse populations.

Purpose of the Study:

• To compare the 2-year risk of complicated UGIB among new users of different DOACs in a Chinese population.
• To identify potential differences in safety profiles among apixaban, dabigatran, edoxaban, and rivaroxaban.

Main Methods:

• A population-based, retrospective cohort study in Hong Kong (2011-2020) included new users of apixaban, dabigatran, edoxaban, or rivaroxaban.
• Inverse probability of treatment weighting (IPTW) balanced baseline characteristics.
• Fine-Gray models analyzed subdistribution hazard ratios (S-HR) for complicated UGIB, with non-UGIB deaths as competing risks.

Main Results:

• Among 58,229 new DOAC users, edoxaban (S-HR=1.891) and rivaroxaban (S-HR=1.441) were associated with significantly higher risks of complicated UGIB compared to apixaban.
• Dabigatran did not show a significantly different risk compared to apixaban.
• Apixaban demonstrated a lower bleeding risk in elderly patients (≥80 years) and those with reduced kidney function (eGFR <60 mL/min/1.73m²).

Conclusions:

• Apixaban use was associated with a lower 2-year risk of complicated UGIB compared to edoxaban and rivaroxaban in this Chinese population.
• These findings suggest apixaban may be a safer choice for preventing complicated UGIB in Asian patients initiating anticoagulation.
• Further research should validate these findings across different ethnicities and healthcare settings.