Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia

Research output: Contribution to journal › Journal article › Research › peer-review

Standard

Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. / Al-Hussainy, Nour; Kragholm, Kristian Hay; Lundbye-Christensen, Søren; Torp-Pedersen, Christian; Pareek, Manan; Therkelsen, Susette Krohn; Lip, Gregory Y.H.; Riahi, Sam.

In: Thrombosis Research, Vol. 232, 2023, p. 62-69.

Research output: Contribution to journal › Journal article › Research › peer-review

Harvard

Al-Hussainy, N, Kragholm, KH, Lundbye-Christensen, S, Torp-Pedersen, C, Pareek, M, Therkelsen, SK, Lip, GYH & Riahi, S 2023, 'Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia', Thrombosis Research, vol. 232, pp. 62-69. https://doi.org/10.1016/j.thromres.2023.10.013

APA

Al-Hussainy, N., Kragholm, K. H., Lundbye-Christensen, S., Torp-Pedersen, C., Pareek, M., Therkelsen, S. K., Lip, G. Y. H., & Riahi, S. (2023). Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. Thrombosis Research, 232, 62-69. https://doi.org/10.1016/j.thromres.2023.10.013

Vancouver

Al-Hussainy N, Kragholm KH, Lundbye-Christensen S, Torp-Pedersen C, Pareek M, Therkelsen SK et al. Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. Thrombosis Research. 2023;232:62-69. https://doi.org/10.1016/j.thromres.2023.10.013

Author

Al-Hussainy, Nour ; Kragholm, Kristian Hay ; Lundbye-Christensen, Søren ; Torp-Pedersen, Christian ; Pareek, Manan ; Therkelsen, Susette Krohn ; Lip, Gregory Y.H. ; Riahi, Sam. / Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. In: Thrombosis Research. 2023 ; Vol. 232. pp. 62-69.

Bibtex

@article{df69f9b15549454283b9c7812b4865c7,

title = "Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia",

abstract = "Introduction: A high risk of gastrointestinal bleeding has been reported with the use of some direct oral anticoagulants (DOACs). This risk may be of particular concern in individuals with associated anaemia. The aim of this study is to investigate potential differences in the risks of gastrointestinal bleeding and stroke among the four available DOACs in patients with atrial fibrillation (AF) and moderate or severe anaemia. Materials and methods: All Danish patients diagnosed with incident AF who had a baseline haemoglobin measurement and subsequently initiated DOAC therapy between 2012 and 2021 were identified through administrative registries. Only patients with moderate or severe anaemia (N = 7269) were included and evaluated regarding the risk of hospitalization for gastrointestinal bleeding and stroke. Standardized absolute 1-year risks of stroke and gastrointestinal bleeding were calculated from multivariable Cox regression analyses. DOACs were compared pairwise Results: Compared with apixaban, both dabigatran and rivaroxaban were associated with a significantly increased risk of gastrointestinal bleeding with standardized 1-year risk ratios of 1.73 (95 % confidence interval [CI], 1.10–2.35) and 1.56 (95 % CI, 1.18–1.93), respectively, while no significant difference was seen in the comparison of apixaban with edoxaban 1.32 (95 % CI, 0.41–2.32). No significant differences in gastrointestinal bleeding were observed with pairwise comparisons of dabigatran, rivaroxaban and edoxaban. Finally, no significant difference in stroke risk among the four DOACs was observed. Conclusion: In AF patients with moderate or severe anaemia, apixaban was associated with a significantly lower risk of gastrointestinal bleeding than dabigatran and rivaroxaban. No significant difference in stroke risk was observed across all four available DOACs.",

keywords = "Anaemia, Atrial fibrillation, Direct oral anticoagulants, Gastrointestinal bleeding, Stroke",

author = "Nour Al-Hussainy and Kragholm, {Kristian Hay} and S{\o}ren Lundbye-Christensen and Christian Torp-Pedersen and Manan Pareek and Therkelsen, {Susette Krohn} and Lip, {Gregory Y.H.} and Sam Riahi",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

doi = "10.1016/j.thromres.2023.10.013",

language = "English",

volume = "232",

pages = "62--69",

journal = "Thrombosis Research",

issn = "0049-3848",

publisher = "Pergamon Press",

}

RIS

TY - JOUR

T1 - Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia

AU - Al-Hussainy, Nour

AU - Kragholm, Kristian Hay

AU - Lundbye-Christensen, Søren

AU - Torp-Pedersen, Christian

AU - Pareek, Manan

AU - Therkelsen, Susette Krohn

AU - Lip, Gregory Y.H.

AU - Riahi, Sam

PY - 2023

Y1 - 2023

N2 - Introduction: A high risk of gastrointestinal bleeding has been reported with the use of some direct oral anticoagulants (DOACs). This risk may be of particular concern in individuals with associated anaemia. The aim of this study is to investigate potential differences in the risks of gastrointestinal bleeding and stroke among the four available DOACs in patients with atrial fibrillation (AF) and moderate or severe anaemia. Materials and methods: All Danish patients diagnosed with incident AF who had a baseline haemoglobin measurement and subsequently initiated DOAC therapy between 2012 and 2021 were identified through administrative registries. Only patients with moderate or severe anaemia (N = 7269) were included and evaluated regarding the risk of hospitalization for gastrointestinal bleeding and stroke. Standardized absolute 1-year risks of stroke and gastrointestinal bleeding were calculated from multivariable Cox regression analyses. DOACs were compared pairwise Results: Compared with apixaban, both dabigatran and rivaroxaban were associated with a significantly increased risk of gastrointestinal bleeding with standardized 1-year risk ratios of 1.73 (95 % confidence interval [CI], 1.10–2.35) and 1.56 (95 % CI, 1.18–1.93), respectively, while no significant difference was seen in the comparison of apixaban with edoxaban 1.32 (95 % CI, 0.41–2.32). No significant differences in gastrointestinal bleeding were observed with pairwise comparisons of dabigatran, rivaroxaban and edoxaban. Finally, no significant difference in stroke risk among the four DOACs was observed. Conclusion: In AF patients with moderate or severe anaemia, apixaban was associated with a significantly lower risk of gastrointestinal bleeding than dabigatran and rivaroxaban. No significant difference in stroke risk was observed across all four available DOACs.

AB - Introduction: A high risk of gastrointestinal bleeding has been reported with the use of some direct oral anticoagulants (DOACs). This risk may be of particular concern in individuals with associated anaemia. The aim of this study is to investigate potential differences in the risks of gastrointestinal bleeding and stroke among the four available DOACs in patients with atrial fibrillation (AF) and moderate or severe anaemia. Materials and methods: All Danish patients diagnosed with incident AF who had a baseline haemoglobin measurement and subsequently initiated DOAC therapy between 2012 and 2021 were identified through administrative registries. Only patients with moderate or severe anaemia (N = 7269) were included and evaluated regarding the risk of hospitalization for gastrointestinal bleeding and stroke. Standardized absolute 1-year risks of stroke and gastrointestinal bleeding were calculated from multivariable Cox regression analyses. DOACs were compared pairwise Results: Compared with apixaban, both dabigatran and rivaroxaban were associated with a significantly increased risk of gastrointestinal bleeding with standardized 1-year risk ratios of 1.73 (95 % confidence interval [CI], 1.10–2.35) and 1.56 (95 % CI, 1.18–1.93), respectively, while no significant difference was seen in the comparison of apixaban with edoxaban 1.32 (95 % CI, 0.41–2.32). No significant differences in gastrointestinal bleeding were observed with pairwise comparisons of dabigatran, rivaroxaban and edoxaban. Finally, no significant difference in stroke risk among the four DOACs was observed. Conclusion: In AF patients with moderate or severe anaemia, apixaban was associated with a significantly lower risk of gastrointestinal bleeding than dabigatran and rivaroxaban. No significant difference in stroke risk was observed across all four available DOACs.

KW - Anaemia

KW - Atrial fibrillation

KW - Direct oral anticoagulants

KW - Gastrointestinal bleeding

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85175811444&partnerID=8YFLogxK

U2 - 10.1016/j.thromres.2023.10.013

DO - 10.1016/j.thromres.2023.10.013

M3 - Journal article

C2 - 37939578

AN - SCOPUS:85175811444

VL - 232

SP - 62

EP - 69

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

ER -

ID: 373467411