A0297 - Incidence of Major Gastrointestinal Bleeding in Veterans Taking Apixaban vs Rivaroxaban

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ammar Ahmad, MD

Wright State University Boonshoft School of Medicine
Tipp City, OH

Ammar Ahmad, MD¹, Chris Casaccio, DO², Amanda Peck, ¹, Shaina Ailawadi, BS¹, Ronald Markert, PhD¹, Sangeeta Agrawal, MD³
¹Wright State University Boonshoft School of Medicine, Dayton, OH; ²Wright State University Boonshoft School of Medicine/Wright Patterson AFB, Columbus, OH; ³Dayton VA Medical Center, Dayton, OH

Introduction: Gastrointestinal bleeding (GIB) is one of the major adverse effects of Direct oral anticoagulants (DOACs). The incidence of GIB has been extensively compared between Warfarin and DOACs but population-based studies comparing incidence of GIB among different DOACs are limited. The objective of our study was to compare the incidence of GIB in veterans taking apixaban vs. rivaroxaban.

Methods: We retrospectively evaluated electronic medical records of veterans at Dayton VA medical center who were started on apixaban and rivaroxaban between 2012 and 2020. Demographics, HAS BLED Score, and duration of anticoagulation were collected. Outcome included admission to the hospital for gastrointestinal bleeding. SPSS was used to calculate incidence of GIB per 100 years of usage and incidence rate ratio.

Results: In total, 2170 veterans were started on apixaban, and 677 veterans were started on rivaroxaban between 2012 and 2020. Of these patients, 2781 were male and 66 were female. Patients started on apixaban were older than patients started on rivaroxaban (73.1 years vs. 67.6 years, p < 0.001). The duration of treatment on rivaroxaban was slightly higher than apixaban (2.02 years vs. 1.90 years, p = 0.09). HAS BLED score of patients started on apixaban was significantly higher than patient started on rivaroxaban (2.22 vs. 1.84, p < 0.001). The incidence of GIB in patients taking apixaban was 0.996 per 100 years of usage, whereas the incidence of GIB in patients taking rivaroxaban was 1.314 per 100 years of usage. The incidence rate ratio of GIB between patients taking rivaroxaban vs. apixaban was 1.32.

Discussion: In our study, the incidence of GIB was higher in patients on rivaroxaban even though they had lower mean age and HAS BLED scores. Apixaban should be considered first in patients requiring anticoagulation with higher risk of bleeding. Our study is limited to the veteran population which is predominantly male. Further population-based studies should be performed to compare the risk of GIB among patients on different DOACs.

	Apixaban (N = 2170)	Rivaroxaban (N = 677)
Age (Mean ± St. Deviation)	73.1 ± 10.41	67.56 ± 10.67
Male	2123	658
Female	47	19
Caucasian	1929	642
African American	187	27
Other	54	8
HAS BLED Score (Mean ± St. Deviation)	2.22 ± 1.07	1.84 ± 0.89
Duration of anti-coagulation (Mean ± St. Deviation)	1.90 ± 1.47	2.02 ± 1.78
Incidence of Major GI Bleed per 100 years of usage	0.996	1.314

Table: Table 1: Incidence of Major GI Bleed in veterans taking apixaban vs. rivaroxaban

Disclosures:

Ammar Ahmad indicated no relevant financial relationships.

Chris Casaccio indicated no relevant financial relationships.

Amanda Peck indicated no relevant financial relationships.

Shaina Ailawadi indicated no relevant financial relationships.

Ronald Markert indicated no relevant financial relationships.

Sangeeta Agrawal indicated no relevant financial relationships.

Ammar Ahmad, MD¹, Chris Casaccio, DO², Amanda Peck, ¹, Shaina Ailawadi, BS¹, Ronald Markert, PhD¹, Sangeeta Agrawal, MD³. A0297 - Incidence of Major Gastrointestinal Bleeding in Veterans Taking Apixaban vs Rivaroxaban, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.