title: A Comparison of the Rate of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants or Warfarin.
abstract: Early reports suggested that the risk of gastrointestinal bleeding (GIB) was higher for patients on non-vitamin K antagonist oral anticoagulants (NOACs) than for those on warfarin. We compared the incidence of GIB in our patients on NOACs with those on warfarin.
  
  
  
  We used our VA pharmacy database to identify patients taking NOACs (dabigatran, rivaroxaban, and apixaban) or warfarin between January 2011 and June 2015, and used the VistA system to identify those who were hospitalized for GIB. We included only patients with clinically significant GIB, defined as documented GI blood loss with a hemoglobin drop ≥2 g/dl, hemodynamic instability, and/or need for endoscopic evaluation, angiography, or surgery.
  
  
  
  We identified 803 patients on NOACs and 6,263 on warfarin. One hundred and fifty-eight patients on warfarin had GIB (2.5%), compared with only five patients (0.6%) on NOACs (odds ratio=4.13; 95% confidence interval: 1.69-10.09). Blood transfusion for GIB was significantly more common in patients on warfarin than on NOACs (64.6% vs. 20%, P=0.04). Within 90 days of GIB hospitalization, 12 patients (7.6%) in the warfarin group died, whereas there were no deaths in the NOAC group.
  
  
  
  In our patients, the incidence of GIB for those on warfarin was more than four times that for those on NOACs. Blood transfusions for GIB were more common in warfarin patients, and no NOAC patients died of GIB. In contrast to early reports, our findings suggest that the risk of GIB and subsequent complications is considerably lower for patients on NOACs than for patients on warfarin.
authors.affiliation: Department of Medicine, Division of Gastroenterology (111B1), VA North Texas Healthcare System, Dallas VA Medical Center, Dallas, Texas, USA.|Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cangemi
authors.affiliation: Department of Medicine, Division of Gastroenterology (111B1), VA North Texas Healthcare System, Dallas VA Medical Center, Dallas, Texas, USA.|Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Krill
authors.affiliation: Department of Pharmacy, VA North Texas Healthcare System, Dallas, Texas, USA.
authors.forename: Rick
authors.initials: R
authors.lastname: Weideman
authors.affiliation: The College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA.
authors.forename: Daisha J
authors.initials: DJ
authors.lastname: Cipher
authors.affiliation: Department of Medicine, Division of Gastroenterology (111B1), VA North Texas Healthcare System, Dallas VA Medical Center, Dallas, Texas, USA.|Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Spechler
authors.affiliation: Department of Medicine, Division of Gastroenterology (111B1), VA North Texas Healthcare System, Dallas VA Medical Center, Dallas, Texas, USA.|Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Feagins
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001803:Blood Transfusion; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D011655:Pulmonary Embolism / Q000517:prevention & control; D011720:Pyrazoles / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use*; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran