Gastrointestinal Bleeding Associated with Dabigatran or Rivaroxaban Is Similar to That Associated with Warfarin

In randomized trial of treatment for atrial fibrillation, the novel oral anticoagulants, dabigatran (Pradaxa) and rivaroxaban (Xarelto), were associated with slightly higher risk for gastrointestinal (GI) bleeding than was warfarin (NEJM JW Gen Med Feb 1 2014 and Lancet 2014; 383:955); in trials of treatment for thromboembolism, GI bleeding risks with novel anticoagulants and warfarin were similar (NEJM JW Gen Med Jan 1 2015 and Blood 2014; 124:1968). But how is this playing out in real-world use?

In a retrospective study, researchers used a large administrative database of commercially insured patients and compared risk for GI bleeding among 46,000 new adult users of dabigatran, rivaroxaban, and warfarin. After adjusting for multiple potent…