Direct oral anticoagulant agents increase the risk of gastrointestinal (GI) bleeding.
Dr Neena Abraham and colleagues from Arizona, USA investigated which direct oral anticoagulant had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding.
The researchers conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees.
The team created 3 propensity-matched cohorts of patients with non-valvular atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from 2010 through 2015.
|Rates of events for all direct oral anticoagulants increased among patients 75 years or older|
The research team compared data on rivaroxaban vs dabigatran for 31,574 patients, data on apixaban vs dabigatran for 13,084 patients, and data on apixaban vs rivaroxaban for 13,130 patients.
Baseline characteristics were well balanced among sub-cohorts.
The team found that GI bleeding occurred more frequently in patients given rivaroxaban than dabigatran.
The research team found that apixaban was associated with a lower risk of GI bleeding than dabigatran or rivaroxaban.
Rates of events for all direct oral anticoagulants increased among patients 75 years or older.
The team found that apixaban had a lower risk of association with GI bleeding in the very elderly than dabigatran or rivaroxaban.
The researchers observed that median times to GI bleeding were <90 days for apixaban and rivaroxaban, and <120 days for dabigatran.
Dr Abraham's team concludes, "In a population-based study of patients receiving direct oral anticoagulant agents, we found apixaban had the most favorable GI safety profile and rivaroxaban the least favorable profile."
"GI bleeding events among patient aged 75 years or older taking direct oral anticoagulant agents increased with age."
"The risk was greatest among persons 75 years."
"Apixaban had the most favorable GI safety profile among all age groups."