Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-232 - Non-vitamin K Antagonist Oral Anticoagulants In Patients With Atrial Fibrillation And Prior Gastrointestinal Bleeding (ID 1072)

 S. Kwon: Nothing relevant to disclose.


Background: There are controversial results on the risk of gastrointestinal bleeding (GIB) of direct oral anticoagulants (NOAC) in patients with atrial fibrillation (AF).
Objective: This study aimed to evaluate the effectiveness and safety of NOAC compared to warfarin in patients with AF and prior GIB.
Methods: Using the Korean Health Insurance Review and Assessment database, we included OAC naïve non-valvular AF patients with a prior history of GIB from January 2010 to April 2018. To balance between patients with NOAC and warfarin, we used the inverse probability of treatment weighting method (IPTW). The primary outcomes were an ischemic stroke, major bleeding, and the composite outcome (either of the previous two). The secondary outcomes were fatal events for each primary outcome.
Results: A total of 42,048 individuals, 17,267 were treated with warfarin and 24,781 for NOAC. After IPTW, the baseline characteristics were well balanced (mean age 71.8 years, male 56.8%, mean CHA2DS2-VASc score 3.7). Compared to warfarin, NOAC was associated with lower risks of ischemic stroke, major bleeding, and composite outcome, respectively; weighted hazard ratio (HR) 0.61 95% confidence interval (CI) 0.54-0.68; HR 0.73 95% CI 0.64-0.83; HR 0.66 95% CI 0.61-0.72; respectively, for all p-values <0.001 (Figure). The risk of major bleeding was still lower than that of warfarin even when only standard doses of NOAC were analyzed (HR 0.74 95% CI 0.61-0.88. For all secondary outcomes, NOAC showed greater risk reductions than warfarin.
Conclusion: Compared to warfarin, NOAC may be associated with lower risks of ischemic stroke, major bleeding, and composite outcomes among AF patients with prior GIB.