Comparing risk of major bleeding between users of different oral anticoagulants in patients with nonvalvular atrial fibrillation.
Patrick C SouvereinHendrika A van den HamConsuelo Huerta-ÁlvarezElisa Martín MerinoDolores MonteroLuz M León-MuñozSven SchmiedlAndreas HeekeMarietta RottenkolberMorten AndersenMia AakjaerMarie Louise De BruinOlaf H KlungelHelga GardarsdottirPublished in: British journal of clinical pharmacology (2020)
Overall, 251 719 patients were included across the 4 study cohorts (mean age ~75 years, % females between 41.3 and 54.3%), with overall hazard ratios of major bleeding risk for DOACs vs VKAs ranging between 0.84 (95% CI: 0.79-0.90) in Denmark and 1.13 (95% CI 1.02-1.25) in the UK. When stratifying according to the bleeding site, risk of gastrointestinal bleeding was increased by 48-67% in dabigatran users and 30-50% for rivaroxaban users compared to VKA users in all data sources except Denmark. Compared to VKAs, apixaban was not associated with an increased risk of gastrointestinal bleeding in all data sources and seemed to be associated with the lowest risk of major bleeding events compared to dabigatran and rivaroxaban.
Keyphrases
- atrial fibrillation
- oral anticoagulants
- direct oral anticoagulants
- catheter ablation
- left atrial
- left atrial appendage
- end stage renal disease
- heart failure
- percutaneous coronary intervention
- electronic health record
- big data
- ejection fraction
- drinking water
- newly diagnosed
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- patient reported
- coronary artery disease
- venous thromboembolism
- acute coronary syndrome
- pulmonary embolism