Abstract Number: PB2463
Meeting: ISTH 2020 Congress
Background: Direct oral anticoagulants (DOACs) have a better safety profile compared with warfarin. However, the real-world data specifically in Asian patients are lacking.
Aims: To determine the rates, clinical outcomes and risk factors for mortality in patients who had major bleeding while receiving DOACs.
Methods: This is a retrospective cohort study from 2010 to 2019. The medical records of all patients with major bleeding from DOACs according to ISTH criteria were reviewed.
Results: During the study period, 13,541 patients received oral anticoagulants; warfarin (10,517), dabigatran (425), rivaroxaban (1,622), apixaban (903) and edoxaban (74). There were 298 bleeding events (2.2%); 248 cases (2.4%) from warfarin and 50 cases (1.7%) from DOACs. Major bleeding rates in warfarin-treated and DOAC-treated patients were 1.5% (163) and 1.1% (34), respectively. Major bleeding events occurred in patients receiving dabigatran (12), rivaroxaban (12), apixaban (9) and edoxaban (1). The mean age of patients with major bleeding was 79±9 years (range 49-95) and 55.9% were male. The sites of bleeding were shown in Table 1. The majority of DOAC bleeding (50%) were managed with surgical or endoscopic treatments for gastrointestinal bleeding (50%). Red blood cell transfusion was given in 19 cases (55.9%). Furthermore, 7 (20.6%) cases received prothrombin complex concentrate and 5 received (14.7%) idarucizumab. Compared with DOACs, warfarin was associated with both intracerebral hemorrhage (ICH) (Relative risk [RR] 2.80, 95% confidence interval [CI] 1.01-7.84) and gastrointestinal (GI) bleeding (RR 2.05, 95%CI, 1.22-3.45). The case-fatality rates were shown in Table 1. After adjusting for age, sex, and anticoagulant type, ICH (Odds ratio [OR] 2.8, 95% CI 1.01 -7.87) was associated with an increased risk of deaths.
Conclusions: In our study, DOACs showed lower rates of ICH and GI bleeding compared with warfarin. The case-fatality rate was also lower. ICH was associated with higher mortality.
|Warfarin (n=248)||DOACs (n=50)|
|Major bleeding, n||163||34|
|-Gastrointestinal bleeding, n (%)||114 (69.9%)||16 (47.1%)|
|-Intracranial bleeding, n (%)||39 (23.9%)||9 (26.5%)|
|-Retroperitoneal bleeding, n (%)||6 (3.7%)||3 (8.8%)|
|-Genitourinary tract bleeding, n (%)||0||2 (5.9%)|
|-Intraarticular bleeding||0||1 (2.9%)|
|-Bleeding in other sites, n (%)||4 (2.5%)||3 (8.8%)|
|Case-fatality rate (%) -Total bleeding cases||12.9%||8%|
|Case-fatality rate (%) -Major bleeding cases||19.6%||11.8%|
[Table 1 Sites of bleeding and case-fatality rate of warfarin and direct oral anticoagulants (DOACs)]
To cite this abstract in AMA style:Kijrattanakul P, Rojnuckarin P. Major Bleeding Complications from Direct Oral Anticoagulants in Thai Adult Patients [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/major-bleeding-complications-from-direct-oral-anticoagulants-in-thai-adult-patients/. Accessed December 10, 2023.
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