The post-2010 introduction of direct oral anticoagulants was associated with a significantly higher need for blood transfusions among atrial fibrillation patients with gastrointestinal bleeding compared to the pre-2010 era.
Cohort (n=121,077)
Yes
Does the introduction of DOACs (post-2010 era) increase the severity and complications of gastrointestinal bleeding in patients with atrial fibrillation compared to the pre-DOAC era?
The post-2010 era of DOAC use in atrial fibrillation is associated with more severe gastrointestinal bleeding complications, including higher rates of blood transfusions, shock, and acute kidney injury, compared to the pre-2010 era.
Effect estimate: t-statistics=-0.023 (95% CI -0.031, -0.014)
Absolute Event Rate: 791% vs 611%
p-value: p=<0.0001
Atrial fibrillation (AF) is commonly treated with anticoagulant therapy, which is effective in reducing stroke risk. However, it can increase the likelihood of gastrointestinal (GI) complications. The literature on GI bleeding related to direct oral anticoagulants (DOACs) has expanded significantly since their approval, revealing both benefits and risks. Data from 66 healthcare organizations across the United States in the TriNetX database were studied. Adult patients with a history of AF and a subsequent history of GI bleeding were included. The study population was divided into pre-2010 and post-2010 cohorts. Our results showed there were statistically significant differences between patients in the post-2010 group and those in the pre-2010 group in their need for blood transfusion. There was also a statistically significant difference in the number of patients who needed an upper endoscopy. Patients who had an International Classification of Diseases (ICD)-10 code of any type of shock showed statistical significance with more patients having shock as a diagnosis after 2010 versus before. The results of this study reveal significant clinical implications following the introduction of DOACs in managing AF. The increase in blood transfusions likely reflects heightened bleeding risks associated with DOACs, particularly in patients with pre-existing GI issues. Additionally, the rise in upper endoscopies suggests clinicians have become more proactive in investigating GI complications, driven by increased awareness of anticoagulant risks.
Haddadin et al. (Thu,) conducted a cohort in Atrial fibrillation with subsequent gastrointestinal bleeding (n=121,077). Direct oral anticoagulants (DOACs) introduction (Post-2010 era) vs. Pre-2010 era (before DOAC introduction) was evaluated on Need for blood transfusion (t-statistics=-0.023, 95% CI -0.031, -0.014, p=<0.0001). The post-2010 introduction of direct oral anticoagulants was associated with a significantly higher need for blood transfusions among atrial fibrillation patients with gastrointestinal bleeding compared to the pre-2010 era.