Key result
DOACs are linked to a shorter GI bleeding latency of ~3 months versus VKAs.
Why the study?
Patients receiving VKAs and DOACs have an increased risk of gastrointestinal bleeding, prompting a comparison of risk factors, scores, timing, location, severity, and outcome between the two drug classes.
Do risk factors, severity, and timing of gastrointestinal bleeding differ between patients receiving direct oral anticoagulants versus vitamin K antagonists?
Observational (n=248)
No
Do risk factors, severity, and timing of gastrointestinal bleeding differ between patients receiving direct oral anticoagulants versus vitamin K antagonists?
Answers are grounded in this paper and cite their sources.
While DOACs are associated with an earlier onset of gastrointestinal bleeding compared to VKAs, there is no significant difference in bleeding severity, length of hospitalization, or mortality between the two anticoagulant classes.
Aim: Patients receiving oral anticoagulants with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have an increased risk of gastrointestinal bleeding (GIB). We compared cases of GIB associated with VKAs and DOACs in terms of risk factors, scores, timing, location, severity, and outcome.Methods: Data from patients treated at a university hospital in Switzerland for GIB under VKA and DOACs between 2012 and 2018 were analyzed in this investigator-driven, retrospective, single-center study. Results: A total of 248 patients (110 males; median age, 80 years; 134 VKA, 114 DOAC) were included. No significant differences in age, weight or sex were observed. The propensity of the VKA group for risk factors such as comorbidities, interacting medications, or a high risk for bleeding (HAS-BLED score) was higher than that of the DOAC group. 56% of the VKA-treated patients had a supratherapeutic INR, and 25% in the DOAC group received an unlicensed dose. Significantly more patients in the DOAC group were not formally overdosed with OAC whilst receiving amiodarone compared to the VKA group (57% vs. 18%, respectively, p = 0.03). Latency between the documented start of oral anticoagulation and GIB was shorter in the DOAC group (median 3 months) than in the VKA group (median 23.5 months, p<0.001). There were no differences in terms of location and severity of the GIB, length of hospitalization, or mortality. Conclusion: Patients taking VKAs displayed more risk factors for GIB than those taking DOACs. Treatment with DOACs was associated with early GIB and calls for increased vigilance during the first months after commencement. Co-medication with amiodarone appeared to be a risk factor for GIB in patients taking DOACs.
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Dongre et al. (2022) conducted an observational in Gastrointestinal bleeding under oral anticoagulation (n=248). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Latency time between starting oral anticoagulation and gastrointestinal bleeding (median months) (p=<0.001). Treatment with direct oral anticoagulants was associated with a significantly shorter latency to gastrointestinal bleeding (median 3 months) compared to vitamin K antagonists (median 23.5 months).
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