A study published Oct. 12 in the Annals of Internal Medicine that compared three types of direct oral anticoagulants (DOACs) found that rivaroxaban was associated with a much higher risk of overall and major gastrointestinal bleeding than apixaban or dabigatran, according to a study. Other studies yield similar results.

The researchers found that compared with apixaban, rivaroxaban had higher overall rates of GIB for all patients and higher rates of major GIB. Higher GIB rates were also seen for rivaroxaban versus dabigatran.

DOACs treat conditions such as atrial fibrillation, venous thromboembolism, and ischemic stroke and are known to cause GI bleeding.

Compared with apixaban or dabigatran, rivaroxaban had higher rates of overall GIB when only patients with atrial fibrillation were included.

Conclusion:

Rivaroxaban was associated with higher GIB rates than apixaban and dabigatran regardless of treatment indication.

Take Home Message:

“From the clinician’s perspective, it is important to take away that there may be differences among the DOACs in terms of where in the GI tract the bleeding occurs”. In the study, the greatest differences appeared to be in the upper GI tract, with rivaroxaban outpacing apixaban and dabigatran. In patients who are at risk for upper GI bleeding, it may be reasonable to consider use of dabigatran or apixaban

The results could help guide DOAC selection for high-risk groups with a prior history of peptic ulcer disease or major GI bleeding.

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