Key result
Rivaroxaban was associated with a lower incidence of gastrointestinal bleeding compared to warfarin in patients with atrial fibrillation and bleeding risk factors (34% vs 61%, P=0.001).
Why the study?
Information on the risk of gastrointestinal bleeding with rivaroxaban versus warfarin in Iran was inadequate to guide anticoagulation prophylaxis in high-risk patients.
Does rivaroxaban reduce the incidence of gastrointestinal bleeding compared to warfarin in patients with atrial fibrillation and concomitant bleeding risk factors?
Observational (n=200)
No
Does rivaroxaban reduce the incidence of gastrointestinal bleeding compared to warfarin in patients with atrial fibrillation and concomitant bleeding risk factors?
In patients with atrial fibrillation and concomitant bleeding risk factors, rivaroxaban was associated with a significantly lower incidence of gastrointestinal bleeding compared to warfarin.
May support rivaroxaban preference in high-bleeding-risk AF; hypothesis-generating and requires randomized confirmation.
BACKGROUND: There is inadequate information on the risk of gastrointestinal (GI) bleeding in patients who are under rivaroxaban and warfarin therapy in Iran. Determining the risk of GI bleeding in patients receiving these two drugs can help to select a more appropriate anti-coagulation prophylaxis in high-risk patients. OBJECTIVE: The aim of this study was to compare the incidence of GI bleeding in patients with atrial fibrillation (AF) and concomitant bleeding risk factors receiving either warfarin or rivaroxaban. METHODS: In this observational study, 200 patients with AF and bleeding risk factors who referred to Imam Hossein Hospital (Tehran, Iran) were included. The patients were under treatment with either warfarin or rivaroxaban. The incidence of GI bleeding was compared between the two groups monthly for one year. RESULTS: GI bleedings were observed in 61% and 34% of patients treated with warfarin and rivaroxaban, respectively (P = 0.001).Melena was the most common type of GI bleeding in both groups. History of hypertension, history of stroke, consumption of anti-platelet drugs, NSAID consumption, and history of alcohol consumption were associated with more frequent GI bleeding only in warfarin group. CONCLUSION: The incidence of GI bleeding was lower in AF patients who received rivaroxaban compared to those treated with warfarin. Also, GI bleeding risk does not change according to the consumption of other anti-coagulant drugs and underlying history of hypertension or stroke in patients received rivaroxaban. Therefore, rivaroxaban is suggested as the choice of prophylaxisin patients with AF and concomitant coagulopathy.
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Sedaghat et al. (2021) conducted an observational in Atrial fibrillation with concomitant bleeding risk factors (n=200). Rivaroxaban vs. Warfarin was evaluated on Incidence of gastrointestinal bleeding (p=0.001). Rivaroxaban was associated with a lower incidence of gastrointestinal bleeding compared to warfarin in patients with atrial fibrillation and bleeding risk factors (34% vs 61%, P=0.001).
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