GI bleeding up for new users of rivaroxaban

Rivaroxaban is associated with increased rates of gastrointestinal bleeding (GIB) compared with other direct oral anticoagulants, according to a study published online Oct. 12 in the Annals of Internal Medicine.

Arnar B. Ingason, M.D., from the University of Iceland in Reykjavík, and colleagues compared rates of GIB among new users of apixaban, dabigatran, and rivaroxaban from 2014 to 2019. Data were included for 2,157 patients receiving apixaban, 494 receiving dabigatran, and 3,217 receiving rivaroxaban.

The researchers found that compared with apixaban, rivaroxaban had higher overall rates of GIB for all patients (3.2 versus 2.5 events per 100 person-years; hazard ratio, 1.42; 95 percent confidence interval, 1.04 to 1.93) and higher rates of major GIB (1.9 versus 1.4 events per 100 person-years; hazard ratio, 1.50; 95 percent confidence interval, 1.00 to 2.24). Higher GIB rates were also seen for rivaroxaban versus dabigatran, with similar point estimates, although the confidence intervals were wider, including the possibility of a null event. Compared with apixaban or dabigatran, rivaroxaban had higher rates of overall GIB when only patients with atrial fibrillation were included (hazard ratios [95 percent confidence intervals], 1.40 [1.01 to 1.94] and 2.04 [1.17 to 3.55], respectively). In both analyses, dabigatran was associated with lower rates of upper GIB compared with rivaroxaban.

"Rivaroxaban was associated with higher rates of GIB than apixaban and dabigatran," the authors write. "This may help guide oral anticoagulant selection, especially for patients at high risk for GIB."

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