THURSDAY, Dec. 20, 2018 — For patients initiating oral anticoagulant therapy, the incidence of hospitalization for upper gastrointestinal bleeding is highest and lowest with rivaroxaban and apixaban, respectively, according to a study published in the Dec. 4 issue of the Journal of the American Medical Association.

Wayne A. Ray, Ph.D., from the Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues compared the incidence of hospitalization for upper gastrointestinal tract bleeding in Medicare patients receiving individual anticoagulants with and without proton pump inhibitor (PPI) cotherapy. The cohort included 1,643,123 patients with 1,713,183 new episodes of oral anticoagulant treatment.

The researchers found that the adjusted incidence of hospitalization for upper gastrointestinal tract bleeding was 115 per 10,000 person-years during 754,389 treatment person-years without PPI cotherapy. The incidence of hospitalizations for rivaroxaban was 144 per 10,000 person-years compared with 73 per 10,000 person-years for apixaban (incidence rate ratio [IRR], 1.97), 120 per 10,000 person-years for dabigatran (IRR, 1.19), and 113 per 10,000 person-years for warfarin (IRR, 1.27). The incidence was significantly lower for apixaban versus dabigatran and warfarin (IRR, 0.61 and 0.64, respectively). Compared with treatment without PPI cotherapy, the risk for hospitalizations for upper gastrointestinal tract bleeding was lower overall for anticoagulant treatment with PPI cotherapy (IRR, 0.66) and for apixaban, dabigatran, rivaroxaban, and warfarin (IRRs, 0.66, 0.49, and 0.75, and 0.65, respectively).

“These findings may inform assessment of risks and benefits when choosing anticoagulant agents,” the authors write.

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Posted: December 2018

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