Key result
NOACs are linked to ~14% lower overall GI bleeding versus warfarin despite higher post-polypectomy bleeding.
Why the study?
Gastrointestinal bleeding risk for NOACs compared with warfarin was largely unknown, motivating an evaluation of overall and post-polypectomy bleeding risks.
Do NOACs compared to warfarin alter the risk of overall and post-polypectomy gastrointestinal bleeding in patients newly prescribed anticoagulants?
Cohort (n=234,206)
Yes
Do NOACs compared to warfarin alter the risk of overall and post-polypectomy gastrointestinal bleeding in patients newly prescribed anticoagulants?
NOACs are associated with a lower overall risk of gastrointestinal bleeding compared to warfarin, but a significantly higher risk of bleeding following gastrointestinal polypectomy.
Answers are grounded in this paper and cite their sources.
NOACs were associated with lower overall but higher post-polypectomy bleeding risk; leaves open optimal periprocedural strategies in observational data.
BACKGROUND/AIMS: Gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin is largely unknown. We aimed to determine the risk of overall and post-polypectomy GIB for NOACs and warfarin. METHODS: Using the Korean National Health Insurance database, we created a cohort of patients who were newly prescribed NOACs or warfarin between July 2015 and December 2017 using propensity score matching (PSM). Kaplan-Meier analysis with log-rank test was performed to compare the risk of overall and post-polypectomy GIB between NOACs (apixaban, dabigatran, and rivaroxaban) and warfarin. Post-polypectomy GIB was defined as bleeding within 1 month after gastrointestinal endoscopic polypectomy. RESULTS: Out of 234,206 patients taking anticoagulants (187,687 NOACs and 46,519 warfarin), we selected 39,764 pairs of NOACs and warfarin users after PSM. NOACs patients showed significantly lower risk of overall GIB than warfarin patients (log-rank P<0.001, hazard ratio, 0.86; 95% confidence interval, 0.78-0.94; P=0.001). Among NOACs, apixaban showed the lowest risk of GIB. In the subgroup of 7,525 patients who underwent gastrointestinal polypectomy (lower gastrointestinal polypectomy 93.1%), 1,546 pairs were chosen for each group after PSM. The NOACs group showed a high risk of post-polypectomy GIB compared with the warfarin group (log-rank P=0.001, hazard ratio, 1.97; 95% confidence interval, 1.16-3.33; P=0.012). CONCLUSIONS: This nationwide, population-based study demonstrates that risk of overall GIB is lower for NOACs than for warfarin, while risk of post-polypectomy GIB is higher for NOACs than for warfarin.
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Pae et al. (2022) conducted a cohort in Indications for oral anticoagulation (n=234,206). Non-vitamin K antagonist oral anticoagulants vs. Warfarin was evaluated on Occurrence of any gastrointestinal bleeding (HR 0.86, 95% CI 0.78-0.94, p=0.001). Non-vitamin K antagonist oral anticoagulants reduced the risk of overall gastrointestinal bleeding compared to warfarin (HR 0.86), but increased the risk of post-polypectomy bleeding (HR 1.97).
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