Warfarin Is Associated With Higher Rates of Upper But Not Lower Gastrointestinal Bleeding Compared with Direct Oral Anticoagulants: A Population-Based Propensity-Weighted Cohort Study

Ingason, Arnar B.; Hreinsson, Jóhann P.; Ágústsson, Arnar S; Lund, Sigrún H.; Rumba, Edward; Pálsson, Daníel A; Reynisson, Indridi E.; Gudmundsdottir, Brynja R.; Önundarson, Páll T.; Bjõrnsson, Einar

doi:10.1016/j.cgh.2022.06.033

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…This is why the most frequent bleeding site was the colon (58%) among the patients with a history of GIB who underwent LAAC in the present study. Regarding the primary disease, angioectasia was the most frequent (47%), which is in line with a previous report 21 . Sites of angioectasia are fragile and bleed easily, especially in anticoagulant users.…”

Section: Discussionsupporting

confidence: 91%

“…Most patients had been taking DOACs before LAAC in the present study. The proportion of new users of DOACs is increasing, 20 and it has been reported that DOAC users have a higher risk of lower GIB in comparison to WF users 21 . This may be explained by the local anticoagulant effects of DOACs 22 .…”

Section: Discussionmentioning

confidence: 99%

“…The proportion of new users of DOACs is increasing, 20 and it has been reported that DOAC users have a higher risk of lower GIB in comparison to WF users. 21 This may be explained by the local anticoagulant effects of DOACs. 22 This is why the most frequent bleeding site was the colon (58%) among the patients with a history of GIB who underwent LAAC in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the primary disease, angioectasia was the most frequent (47%), which is in line with a previous report. 21 Sites of angioectasia are fragile and bleed easily, especially in anticoagulant users. In cases of gastrointestinal diseases for which LAAC is applicable, DOAC users with recurrent lower GIB may be good indications.…”

Section: Discussionmentioning

confidence: 99%

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Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Kikuchi,

Kono,

Nakagawa

et al. 2023

JGH Open

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Background and AimAnticoagulant users with nonvalvular atrial fibrillation (NVAF) sometimes suffer from gastrointestinal bleeding (GIB) and have difficulty continuing the medication. Left atrial appendage closure (LAAC) has been developed for such situations. We aimed to clarify the clinical significance of a history of GIB in comparison to other factors in patients who had undergone LAAC.MethodsFrom October 2019 to September 2023, patients with NVAF who underwent LAAC at our hospital were enrolled. We investigated the percentage of patients with a history of GIB who underwent LAAC and compared the incidence of post‐LAAC bleeding in these patients compared to those with other factors.ResultsA total of 45 patients were included. There were 19 patients (42%) with a history of GIB who underwent LAAC. In a Kaplan–Meier analysis, the cumulative incidence of bleeding complications after LAAC was significantly higher in patients with a history of GIB in comparison to patients with other factors. There were eight cases of post‐LAAC bleeding in total, and seven cases had GIB.ConclusionsWe need to recognize that GIB is a significant complication in patients who undergo LAAC. The management of GIB by gastroenterologists is essential to the success of LAAC.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Kikuchi,

Kono,

Nakagawa

et al. 2023

JGH Open

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“…A previous study from our group demonstrated that only 77% of hospitalized patients with gastrointestinal bleeding (GIB) fulfilled the ISTH criteria of major bleeding. 12 The proportion is likely lower for other bleeding events such as hematuria, epistaxis, postmenopausal bleeding, or unspecified anemia, which have been included as major bleeding in previous studies. 7 , 8 , 10 , 13 , 14 , 15 Thus, population-based real-world studies with well-characterized patients with adequate follow-up are important to elucidate potential differences in the effectiveness and safety of DOACs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of direct oral anticoagulants: a nationwide propensity score–weighted study

et al. 2023

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In the pivotal randomized controlled trials (RCTs) for patients with atrial fibrillation, direct oral anticoagulants (DOACs) had similar or even superior efficacy and safety compared to warfarin. However, RCTs comparing different DOACs are non-existent and previous observational studies have yielded conflicting results. In this nationwide cohort study, rates of any stroke or systemic embolism (stroke/SE) and major bleeding were compared between new users of apixaban, dabigatran, and rivaroxaban with atrial fibrillation from 2014-2019. Inverse probability weighting was used to yield balanced study groups and outcomes were compared using Cox regression. Stroke/SE rates were similar between patients receiving apixaban, dabigatran, and rivaroxaban. Dabigatran was associated with twofold higher rates of myocardial infarction compared to rivaroxaban (1.4 events/100-py vs 0.7 events/100-py, HR 2.21, 95% CI 1.00-4.90) and apixaban (1.4 events/100-py vs 0.7 events/100-py, HR 2.26, 95% CI 0.90-5.67), although the second comparison included the possibility of a null effect. Rivaroxaban was associated with higher major bleeding rates compared to apixaban (2.9 events/100-py vs 1.8 events/100-py, HR 1.64, 95% CI 1.13-2.37) and dabigatran (2.9 events/100-py vs 1.4 events/100-py, HR 2.18, 95% CI 1.21-3.93). Specifically, rivaroxaban had higher rates of major gastrointestinal bleeding and other major bleeding compared to apixaban. In conclusion, while stroke/SE rates were similar between DOACs, rivaroxaban was associated with higher rates of major bleeding compared to other DOACs and lower rates of myocardial infarction compared to dabigatran. These results may help guide oral anticoagulant selection, especially in patients at high risk of bleeding or myocardial infarction.

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Exploring DrugCentral: from molecular structures to clinical effects

Halip,

Avram,

Curpan

et al. 2023

J Comput Aided Mol Des

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DrugCentral, accessible at https://drugcentral.org, is an open-access online drug information repository. It covers over 4950 drugs, incorporating structural, physicochemical, and pharmacological details to support drug discovery, development, and repositioning. With around 20,000 bioactivity data points, manual curation enhances information from several major digital sources. Approximately 724 mechanism-of-action (MoA) targets offer updated drug target insights. The platform captures clinical data: over 14,300 on- and off-label uses, 27,000 contraindications, and around 340,000 adverse drug events from pharmacovigilance reports. DrugCentral encompasses information from molecular structures to marketed formulations, providing a comprehensive pharmaceutical reference. Users can easily navigate basic drug information and key features, making DrugCentral a versatile, unique resource. Furthermore, we present a use-case example where we utilize experimentally determined data from DrugCentral to support drug repurposing. A minimum activity threshold t should be considered against novel targets to repurpose a drug. Analyzing 1156 bioactivities for human MoA targets suggests a general threshold of 1 µM: t = 6 when expressed as − log[Activity(M)]). This applies to 87% of the drugs. Moreover, t can be refined empirically based on water solubility (S): t = 3 − logS, for logS < − 3. Alongside the drug repurposing classification scheme, which considers intellectual property rights, market exclusivity protections, and market accessibility, DrugCentral provides valuable data to prioritize candidates for drug repurposing programs efficiently.

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Warfarin Is Associated With Higher Rates of Upper But Not Lower Gastrointestinal Bleeding Compared with Direct Oral Anticoagulants: A Population-Based Propensity-Weighted Cohort Study

Cited by 12 publications

References 26 publications

Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure

Comparison of the effectiveness and safety of direct oral anticoagulants: a nationwide propensity score–weighted study

Exploring DrugCentral: from molecular structures to clinical effects

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