Which of the Direct Oral Anticoagulants Is the Safest?: Based on Gastrointestinal Bleeding

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=43303). Intervention: Apixaban vs. Dabigatran. Primary outcome: Gastrointestinal bleeding (HR 0.39, 95% CI 0.27-0.58, p=<0.001).

Kyoungwon Jung; Moo In Park

doi:10.4166/kjg.2017.69.5.328

January 1, 2017Korean Journal of GastroenterologyOpen Access

Which of the Direct Oral Anticoagulants Is the Safest?: Based on Gastrointestinal Bleeding

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Study Design

Type

Cohort (n=43,303)

PICO

P

Population

43,303 privately insured US adults with non-valvular atrial fibrillation prescribed direct oral anticoagulants, followed for up to 5 years to assess gastrointestinal bleeding risk.

E

Exposure / Comparator

Apixaban vs Dabigatran

O

Primary Outcome

Gastrointestinal bleeding — HR 0.39 (0.27-0.58), p=<0.001

Main Result

Hazard Ratio: 0.39 (95% CI 0.27–0.58)

p-value: p=<0.001

Limitations

Inability to assess the 110 mg dose of dabigatran as it is not approved in the US.
Differences in follow-up duration among DOAC groups due to varying FDA approval dates.
Unknown potential confounding effects from over-the-counter aspirin, NSAIDs, or proton pump inhibitors.
Potential for unmeasured confounding variables or risk factors for gastrointestinal bleeding.

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Implication

Apixaban may be favored to lower GI bleeding risk in NVAF; leaves open need for randomized confirmation before practice change.

Abstract

Article: Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-based Study

Discussion

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Cite This Study

Jung et al. (2017) conducted a cohort in Non-valvular atrial fibrillation (n=43,303). Apixaban vs. Dabigatran was evaluated on Gastrointestinal bleeding (HR 0.39, 95% CI 0.27-0.58, p=<0.001).

synapsesocial.com/papers/6a9bc584a4013a3476981710 https://doi.org/10.4166/kjg.2017.69.5.328

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Which of the Direct Oral Anticoagulants Is the Safest?: Based on Gastrointestinal Bleeding

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Which of the Direct Oral Anticoagulants Is the Safest?: Based on Gastrointestinal Bleeding

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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