Bleeding Higher With Standard-Dose DOACs in Nonvalvular A-Fib

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by Healthday

Higher rate of bleeding seen with standard- versus reduced-dose DOACs in patients 65 years and older

By Elana Gotkine HealthDay Reporter

THURSDAY, Nov. 16, 2023 (HealthDay News) — For nursing home residents with nonvalvular atrial fibrillation, the rate of bleeding is higher with standard- versus reduced-dose direct acting oral anticoagulants (DOACs), according to a study published online Nov. 6 in the Journal of the American Heart Association.

Kaleen N. Hayes, Pharm.D., Ph.D., from Brown University School of Public Health in Providence, Rhode Island, and colleagues conducted a retrospective cohort study using 2013 to 2017 U.S. Medicare claims linked to Minimum Data Set records. DOAC initiators (those receiving apixaban, dabigatran, or rivaroxaban) aged 65 years or older with nonvalvular atrial fibrillation residing in a nursing home were identified. Propensity scores were used to estimate inverse-probability of treatment weights for DOAC dose.

Overall, 48 percent of the 21,878 DOAC initiators received reduced dosing. The researchers found that standard dosing was associated with a higher rate of bleeding after estimating inverse probability of treatment weights (hazard ratio, 1.18; 9.4 versus 8.0 events per 100 person-years). The highest rates of bleeding were seen in association with standard-dose therapy for those older than 80 years (9.1 versus 6.7 events per 100 person-years) and with a body mass index <30 kg/m2 (9.4 versus 7.4 events per 100 person-years). No association was seen for dosing with mortality or thrombotic events.

“Given the potential harms and unclear benefits of standard DOAC dosing, our results support the use of reduced-dose DOACs for many older adults with multiple chronic medical conditions,” coauthor Sarah Berry, M.D., M.P.H., of Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research in Boston, said in a statement.

Two authors disclosed ties to the biopharmaceutical industry.

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