June 10, 2015
Some NOACs Riskier for GI Bleeding Than Warfarin in
Patients Over 75

Rochester, MN—Newer may not be better when it comes to the novel oral anticoagulants (NOAC) in patients older than 75, according to a new study.

The study led by researchers from the Mayo Clinic in Rochester, MN, and Scottsdale, AZ, showed that for older patients, the risk of gastrointestinal (GI) bleeding is three to five times higher when taking newer anticoagulant medications dabigatran or rivaroxaban compared to using warfarin.

The report was published recently in the British Medical Journal.

For the study, the researchers reviewed the Optum Labs Data Warehouse, a large database including administrative claims data on privately insured and Medicare Advantage enrollees, to identify new users of dabigatran, rivaroxaban, and warfarin from November 1, 2010, to September 30, 2013.

In propensity score matched models, the study found that the risk of gastrointestinal bleeding with novel oral anticoagulants was similar to that with warfarin in atrial fibrillation patients. The risk of gastrointestinal bleeding increased after age 65, however, and, by age 76, the risk exceeded that with warfarin among atrial fibrillation patients taking dabigatran as well as in patients with and without atrial fibrillation taking rivaroxaban.

The newer medications dabigatran and rivaroxaban are as effective as warfarin at preventing blood clots and reducing the risk of stroke and clotting complications while becoming more desirable among some physicians and patients because they do not require regular monitoring required for warfarin users, according to background information in the study.

“The new anticoagulants have really been popular with patients who have previously only had one choice of oral anticoagulant,” said lead author Neena S. Abraham, MD, “They greatly reduce the number of visits to the doctor for monitoring, and are much more convenient for patients. However, they may not be the right choice for everyone.”

Abraham said the risk profile begins to change around age 65.

“In our study, by using the real-world, national data available from the Optum Labs Data Warehouse, we were able to determine that individuals over age 75 have a much higher risk of GI bleeds than younger patients, if using dabigatran or rivaroxaban instead of warfarin,” she explained. “Our findings definitely point toward important age-related risk that merit consideration when doctors are making treatment recommendations.”

U.S. Pharmacist Social Connect