Rivaroxaban Again Shown to Cause More GI Bleeding Than Other Direct Oral Anticoagulants
Douglas K. Rex, MD, MASGE, reviewing Ingason AB, et al. Ann Intern Med 2021 Nov.
In a study from Iceland, investigators compared GI bleeding rates among 3217 patients receiving rivaroxaban, 2157 receiving apixaban, and 494 receiving dabigatran. Patients were excluded if they had end-stage renal disease, a mechanical heart valve, or mitral valve stenosis.
Overall GI bleeding rates per 100 person-years of observation were 3.2 with rivaroxaban, 2.5 with apixaban, and 1.9 with dabigatran. Overall GI bleed rates were 42% higher with rivaroxaban than apixaban, and major GI bleed rates were 50% higher. Rivaroxaban appeared to be associated with increased rates of both upper and lower GI bleeding.
COMMENTFrom a GI bleeding standpoint, rivaroxaban seems the least safe of the direct oral anticoagulants.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Ingason AB, Hreinsson JP, Ágústsson AS, et al. Rivaroxaban is associated with higher rates of gastrointestinal bleeding than other direct oral anticoagulants: a nationwide propensity score-weighted study. Ann Intern Med 2021;174:1493-1502. (https://doi.org/10.7326/m21-1474)
