Background and Aims

While overall gastrointestinal bleeding (GIB) rates have been extensively compared between warfarin and direct oral anticoagulants (DOACs), it is still unclear whether upper and lower GIB rates differ between these types of drugs. This study aimed to compare upper and lower GIB rates between warfarin and DOACs in a nationwide cohort.

Methods

Data on all patients in Iceland who received a prescription for oral anticoagulation from 2014 to 2019 were collected and their personal identification numbers linked to the electronic medical record system of the National University Hospital of Iceland and the 4 regional hospitals in Iceland. Inverse probability weighting was used to yield balanced study groups and rates of overall, major, upper, and lower GIB were compared using Cox regression. All GIB events were manually confirmed by chart review.

Results

Warfarin was associated with higher rates of upper GIB (1.7 events per 100 person-years vs 0.8 events per 100 person-years; hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.26–3.59) but similar rates of lower GIB compared with DOACs. Specifically, warfarin was associated with higher rates of upper GIB compared with apixaban (HR, 2.63; 95% CI, 1.35–5.13), dabigatran (5.47; 95% CI, 1.87–16.05), and rivaroxaban (HR, 1.74; 95% CI, 1.00–3.05). Warfarin was associated with higher rates of major GIB compared with apixaban (2.3 events per 100 person-years vs 1.5 events per 100 person-years; HR, 1.79; 95% CI, 1.06–3.05), but otherwise overall and major GIB rates were similar in warfarin and DOAC users.

Conclusions

Warfarin was associated with higher rates of upper but not overall or lower GIB compared with DOACs. Warfarin was associated with higher rates of major GIB compared with apixaban.

中文翻译：

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与直接口服抗凝剂相比，华法林与上消化道出血的发生率较高有关，但与下消化道出血的发生率无关：一项基于人群的倾向加权队列研究

背景和目标

虽然已对华法林和直接口服抗凝剂 (DOAC) 的总体胃肠道出血 (GIB) 率进行了广泛比较，但仍不清楚这些类型药物的 GIB 率上限和下限是否存在差异。本研究旨在比较全国队列中华法林和 DOAC 之间 GIB 发生率的上限和下限。

方法

收集了 2014 年至 2019 年冰岛所有接受口服抗凝药处方的患者的数据，并将他们的个人识别号码链接到冰岛国立大学医院和冰岛 4 家地区医院的电子病历系统。使用逆概率加权产生平衡的研究组，并使用 Cox 回归比较总体、主要、上部和下部 GIB 的比率。所有 GIB 事件均通过图表审查手动确认。

结果

华法林与较高的上 GIB 发生率相关（每 100 人年 1.7 起事件 vs 每 100 人年 0.8 起事件；风险比 [HR]，2.12；95% 置信区间 [CI]，1.26–3.59），但相似的发生率与 DOAC 相比，GIB 更低。具体而言，与阿哌沙班（HR，2.63；95% CI，1.35-5.13）、达比加群（5.47；95% CI，1.87-16.05）和利伐沙班（HR，1.74；95%）相比，华法林与更高的上消化道出血率相关置信区间，1.00–3.05）。与阿哌沙班相比，华法林与更高的主要 GIB 发生率相关（每 100 人年 2.3 次事件 vs 每 100 人年 1.5 次事件；HR，1.79；95% CI，1.06-3.05），但总体和主要 GIB 发生率均低于在华法林和 DOAC 使用者中相似。

结论

与 DOAC 相比，华法林与较高但与整体或较低 GIB 发生率无关。与阿哌沙班相比，华法林与较高的主要 GIB 发生率相关。