(HealthDay News) — For patients receiving direct oral anticoagulant (DOAC) agents for non-valvular atrial fibrillation, apixaban is associated with a lower risk of gastrointestinal (GI) bleeding than rivaroxaban or dabigatran, according to a study published in the April issue of Gastroenterology.
Neena S. Abraham, MD, from the Mayo Clinic in Scottsdale, Arizona, and colleagues conducted a retrospective study using administrative claims data of privately insured individuals and Medicare Advantage enrollees. Three propensity-matched cohorts of patients with non-valvular atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban were created. Data were compared on rivaroxaban vs dabigatran for 31,574 patients; for apixaban vs dabigatran for 13,084 patients; and for apixaban vs rivaroxaban for 13,130 patients.
The researchers found that GI bleeding occurred more often in patients given rivaroxaban vs dabigatran (hazard ratio, 1.2). The risk of GI bleeding was lower for apixaban vs dabigatran or rivaroxaban (hazard ratios, 0.39 and 0.33, respectively). For apixaban and rivaroxaban, the median times to gastrointestinal bleeding were <90 days, while for dabigatran, the median time was <120 days.
“In a population-based study of patients receiving DOAC agents, we found apixaban had the most favorable GI safety profile and rivaroxaban the least favorable profile ” the authors write.
- Abraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND. Gastrointestinal safety of direct oral anticoagulants: A large population-based study. Gastroenterology. 2017. doi:10.1053/j.gastro.2016.12.018