Gastrointestinal bleeding among oral anticoagulant users: a comprehensive 7-year retrospective review using Türkiye’s national health data system

Sažetak

BackgroundThe comparative risk of gastrointestinal bleeding (GIB) among users of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) is a topic of ongoing debate. This study leverages a comprehensive national health database to evaluate the incidence of GIB, associated risk factors, and post-bleeding management strategies among anticoagulated patients.MethodsUtilizing the Turkish Ministry of Health's e-Nabız system, we conducted a retrospective analysis of patients treated with DOACs and warfarin from January 2017 to July 2023. GIB events were identified using ICD codes, and comorbidities, prior medication use, interventions, and mortality rates were analyzed. Drug survival and switch patterns post-GIB were also evaluated.ResultsOut of 102,545 patients with a GIB event under anticoagulant treatment, DOAC users were older with a higher prevalence of comorbidities, except for chronic kidney disease, compared to VKA users. The annual incidence of GIB was consistently higher in the DOAC group. Despite similar usage rates of gastroprotective and other GI irritant drugs, DOAC users had a marginally higher mortality rate following GIB. Notably, nearly half of the patients discontinued anticoagulation therapy post-GIB, with the highest discontinuation observed in apixaban users.ConclusionThis nationwide study indicates a higher frequency of GIB in DOAC users versus VKA users, with age and comorbidities potentially contributing to this trend. Mortality rates were comparable to previous literature but warrant further investigation. The significant discontinuation rate post-GIB raises concerns about ongoing anticoagulation management. These findings underscore the need for cautious