Journal article
Bleeding Rates in Veterans Affairs Patients with Atrial Fibrillation Who Switch from Warfarin to Dabigatran
The American journal of medicine, Vol.127(12), pp.1179-1185
12/2014
DOI: 10.1016/j.amjmed.2014.07.024
PMCID: PMC7437526
PMID: 25107386
Abstract
Clinical trial data suggest that dabigatran and warfarin have similar rates of major bleeding but higher rates of gastrointestinal bleeding. These findings have not been evaluated outside of a clinical trial. We evaluated the relative risks of any, gastrointestinal, intracranial, and other bleeding for Veterans Affairs patients who switched to dabigatran after at least 6 months on warfarin, compared with patients who continued on warfarin. We used national Veterans Affairs administrative encounter and pharmacy data from fiscal years 2010-2012 to identify 85,344 patients with atrial fibrillation who had been taking warfarin for at least 180 days before June 2011, of whom 1394 (1.7%) received dabigatran (150 mg) during the next 15 months. Dates of the first occurrence of each type of bleed and dates of death from June 2011 to September 2012 were determined. Baseline and time-dependent patient characteristics were identified, including comorbid conditions, stroke and bleeding risk scores, and time in therapeutic range for international normalized ratios. Marginal structural models were used to address selection bias in the longitudinal observational data. Weighted logistic regression models were fit using generalized estimating equations and reflected baseline and time-dependent covariates and weekly indicators of anticoagulant type (warfarin or dabigatran). Compared with patients who never used dabigatran, patients who used dabigatran at least once were younger, were more likely to be white, had lower international normalized ratio time in therapeutic range on warfarin, had lower stroke risk scores, and had similar bleeding risk scores. Overall, 10,734 patients experienced bleeding events, including 131 events after dabigatran use. The risk-adjusted rate of any bleeding was higher with dabigatran compared with warfarin, which was largely driven by a 54% higher risk of gastrointestinal bleeding with dabigatran. Rates of intracranial, other bleeding, and death were similar for dabigatran and warfarin. Dabigatran may increase the likelihood of gastrointestinal bleeds.
Details
- Title: Subtitle
- Bleeding Rates in Veterans Affairs Patients with Atrial Fibrillation Who Switch from Warfarin to Dabigatran
- Creators
- Mary S Vaughan Sarrazin - Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa CityMichael Jones - Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa CityAlexander Mazur - Department of Internal Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa, Iowa CityElizabeth Chrischilles - Department of Epidemiology, College of Public Health, University of Iowa, Iowa CityPeter Cram - Department of Medicine, University of Toronto, Toronto, Ont., Canada
- Resource Type
- Journal article
- Publication Details
- The American journal of medicine, Vol.127(12), pp.1179-1185
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.amjmed.2014.07.024
- PMID
- 25107386
- PMCID
- PMC7437526
- ISSN
- 0002-9343
- eISSN
- 1555-7162
- Grant note
- K18HS021992 / Agency for Healthcare Research and Quality (http://dx.doi.org/10.13039/100000133) K18 / Patient Centered Outcomes Research for Mid-Career and Senior Investigators Health Services Research and Development Service
- Language
- English
- Date published
- 12/2014
- Academic Unit
- Statistics and Actuarial Science; Pharmacy; Health Management and Policy; Epidemiology; Biostatistics; Public Policy Center (Archive); General Internal Medicine; Internal Medicine
- Record Identifier
- 9983985713702771
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