SNFGE SNFGE
 
Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):1014-1022.e1.  
  doi: 10.1053/j.gastro.2016.12.018.  
 
  Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study.  
 
  Abraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND  
  https://www.ncbi.nlm.nih.gov/pubmed/28043907  
 
 

Abstract

BACKGROUND & AIMS:

Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding.

METHODS:

We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with non-valvular atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015. We compared data on rivaroxaban vs dabigatran for 31,574 patients, data on apixaban vs dabigatran for 13,084 patients, and data on apixaban vs rivaroxaban for 13,130 patients. Cox proportional hazards models, stratified by age, were used to estimate rates of total GI bleeding.

RESULTS:

Baseline characteristics were well balanced among sub-cohorts. GI bleeding occurred more frequently in patients given rivaroxaban than dabigatran (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.00-1.45). Apixaban was associated with a lower risk of GI bleeding than dabigatran (HR, 0.39; 95% CI, 0.27-0.58; P < .001) or rivaroxaban (HR, 0.33; 95% CI, 0.22-0.49; P < .001). Rates of events for all DOACs increased among patients 75 years or older. Apixaban had a lower risk of association with GI bleeding in the very elderly than dabigatran (HR, 0.45; 95% CI, 0.29-0.71) or rivaroxaban (HR, 0.39; 95% CI, 0.25-0.61). Median times to GI bleeding were <90 days for apixaban and rivaroxaban and <120 days for dabigatran.

CONCLUSIONS:

In a population-based study of patients receiving DOAC agents, we found apixaban had the most favorable GI safety profile and rivaroxaban the least favorable profile. GI bleeding events among patient aged 75 years or older taking DOACs increased with age; the risk was greatest among persons 75 years. Apixaban had the most favorable GI safety profile among all age groups.

 
Question posée
 
Les nouveaux anticoagulants oraux directs (AOD) ont-ils les mêmes risques de saignement digestif ?
 
Question posée
 
Cette étude rétrospective américaine porte sur la base de données de plaintes médicales d’assurances maladies incluant 43303 patients sous AOD (apixaban, dabigatran et rivaroxaban) pour une ACFA non valvulaire. Le risque de saignement digestif était le plus faible pour l’apixaban et le plus élevé pour le rivaroxaban. Il augmentait après 75 ans quel que soit l’AOD, avec un risque plus faible quel que soit l’âge pour l’apixaban.
 
Commentaires

Une large étude de population en faveur d’un risque de saignement digestif nettement inférieur sous apixaban (EliquisÒ) par rapport aux autres AOD, et ce quel que soit l’âge du patient. A faire passer à nos cardiologues….

 
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