TOPLINE:

The rate of gastrointestinal (GI) bleeding mortality in the US nearly doubled between 2007 and 2020, coinciding with increased prescriptions for direct oral anticoagulants (DOACs). However, the risk for fatal bleeding per anticoagulated patient declined.

METHODOLOGY:

• Anticoagulant therapy is a recognized risk factor for GI bleeding. DOACs have largely replaced warfarin for long-term anticoagulation, but the impact of their widespread use on deaths from GI bleeding remains unclear.
• Researchers conducted an observational study using interrupted time series analysis to compare mortality trends for GI bleeding in the US before and after 2014, a year chosen to represent the start of widespread DOAC adoption.
• They retrieved mortality data on GI bleeding from CDC WONDER (Wide-ranging ONline Data for Epidemiologic Research, 2007-2020) and calculated age-adjusted mortality rates standardized to the 2000 US population.
• DOAC use from 2010 to 2020 was assessed using prescriptions of apixaban, rivaroxaban, dabigatran, and edoxaban from Medicare Part D data and validated market share estimates against national surveys.
• Researchers reported age-adjusted GI bleeding deaths per 100,000 persons and exposure-adjusted deaths per 100,000 estimated DOAC users (using an estimated denominator of 16 million users).

TAKEAWAY:

• The age-adjusted rate of GI bleeding mortality increased from 0.6 to 1.3 per 100,000 persons between 2007 and 2020.
• DOAC prescriptions increased from approximately 30% of oral anticoagulants in 2014 to nearly 70% by 2020, surpassing warfarin prescriptions by 2015-2016.
• The exposure-adjusted rate of GI bleeding mortality decreased from 29.5 to 20.0 deaths per 100,000 DOAC users between 2014 and 2020, reflecting a 32% relative reduction in fatal bleeding risk per anticoagulated patient.
• The interrupted time series analysis showed a significant upward trend before 2014 (P = .047) and found no significant immediate change at the 2014 timepoint or change in slope thereafter.

IN PRACTICE:

“[The study] finding suggests that the overall increase in GI bleed deaths may be primarily attributable to greater anticoagulant utilization and demographic aging, rather than an increased individual fatality risk,” wrote the authors of the study.

SOURCE:

The study was led by Muhammad Haris Latif, SSM Health St. Mary’s Hospital, St. Louis. It was published online in Digestive Diseases and Sciences.

LIMITATIONS:

Death certificates may have misclassified some GI-bleed deaths. Researchers could not link prescriptions to individuals; thus, the analyses could not be adjusted for comorbidities, co-medications, procedures, or DOAC-specific details. Using an estimated number of anticoagulant users and treating 2014 as an immediate change year, despite gradual DOAC uptake, may have biased trend estimates.

DISCLOSURES:

The study did not receive any specific funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.