Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study

A US analysis (n= 46,000) found that neither dabigatran nor rivaroxaban was associated with a statistically significantly increased risk of GI bleeding relative to warfarin. However the study had wide confidence intervals and an increased risk of bleeding cannot be ruled out.

An editorial discusses the findings of this study (and another linked paper) which both report additional evidence on the risks of gastrointestinal bleeding among patients taking the novel oral anticoagulants dabigatran and rivaroxaban.

 

 

The author notes that patients receiving oral anticoagulants for atrial fibrillation are typically older. Furthermore clinical trial data suggest that the increased bioavailability of the newer agents that occurs with age seems to induce a greater increase in bleeding risk than does the same change in bioavailability of warfarin.

 

 

Given the variability in drug absorption that influences bleeding risk, patients taking newer oral anticoagulants might benefit from intermittent monitoring. However “standard” tests for coagulation are not adequate in patients taking the newer agents, and results vary depending on laboratory procedures.