Major GI bleeds with apixaban and edoxaban vs rivaroxaban

  • Clin Epidemiol
  • 1 Oct 2019

  • International Clinical Digest
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Takeaway

  • Major gastrointestinal (MGI) bleeding risk varies significantly among novel oral anticoagulants (NOACs) prescribed to prevent and treat thrombosis, according to a network meta-analysis comparing the safety profiles of apixaban, edoxaban, rivaroxaban, and dabigatran etexilate.

Why this matters

  • Physicians should consider MGI bleeding risk and carefully monitor patients treated with NOACs.

Study design

  • Researchers analysed 25 randomised controlled trials assessing gastrointestinal bleeding in patients treated with NOACs or conventional therapy with warfarin, heparin, or placebo (N=139,392), using a Bayesian random effects model.
  • Funding: None disclosed.

Key results

  • MGI bleeding was fatal in 1.6% of patients (OR, 1.76; P=.015).
  • Compared with conventional regimens, only rivaroxaban was associated with increased risk for MGI bleeding (OR, 1.37; 95% credible interval [CrI], 1.00-1.85).
  • Compared with rivaroxaban, apixaban (OR, 0.56; 95% CrI, 0.35-0.88) and edoxaban (OR, 0.62; 95% CrI, 0.35-0.96) were associated with significantly lower MGI bleeding risk.
  • Apixaban had the highest probability of being associated with the lowest MGI bleeding risk (89.1%), followed by edoxaban (77.4%), conventional therapy (51.4%), dabigatran etexilate (23.8%), and rivaroxaban (8.3%).

Limitations

  • The study did not evaluate the efficacy of NOAC treatments or include a cost-benefit analysis.