Anticoagulation Therapy Improves Bleeding Risk Among Older Adults

Three oral anticoagulants had similar efficacity in preventing stroke among patients with atrial fibrillation (AF) and multiple chronic conditions, according to results of a new analysis. Moreover, dabigatran and rivaroxaban may reduce the rate of mortality among patients with multiple chronic conditions.


The researchers came to this conclusion after comparing the efficacy and safety of dabigatran and rivaroxaban with warfarin in nearly 150,000 patients with multiple chronic conditions. 



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Participants were part of the Medicare Beneficiaries Database, which was a population-based cohort of patients who were newly diagnosed with AF and initiated an oral anticoagulant within 90 days of diagnosis.


Participants were categorized into 1 of 3 groups:

  • The low morbidity group consisted of participants with CHA2DS2-VASc scores of 1 to 3, HAS-BLED scores of 0 to 1, and Gagne comorbidity scores of 0 to 2.
  • The moderate morbidity group consisted of participants with CHA2DS2-VASc scores of 4 to 5, HAS-BLED score of 2, and Gagne comorbidity scores of 3 to 4.
  • The high morbidity group consisted of participants with CHA2DS2-VASc scores of 6 or higher, HAS-BLED scores of 3 or higher, and Gagne comorbidity scores of 5 or higher.


Participants in each group who were taking dabigatran (150 mg twice daily), rivaroxaban (20 mg once daily), or warfarin therapy were matched via 3-way propensity matching.


The relative hazards for the main outcomes of ischemic stroke, major hemorrhage, and death were also evaluated.


Results among the propensity-matched cohorts showed no differences in stroke rates between the anticoagulant groups.


Compared with warfarin, dabigatran reduced the hazard of major hemorrhage among participants with low multiple chronic conditions and showed similar risk among participants with moderate to high multiple chronic conditions.


There was no difference in major hemorrhage between the rivaroxaban and warfarin groups, but rivaroxaban significantly increased the risk for major hemorrhage compared with dabigatran in the medium and high comorbidity groups.


Across comorbidity levels, dabigatran and rivaroxaban reduced the rates of death compared with warfarin.


“Rivaroxaban and dabigatran are effective in elderly patients with multiple chronic conditions, but dabigatran appears to be associated with lower bleeding rates,” the researchers concluded.


—Amanda Balbi



Mentias A, Shantha G, Chaudhury P, Vaughan Sarrazin MS. Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis [published online September 28, 2018]. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.2870.