Risk factors and prevention of dabigatran-related gastrointestinal bleeding in patients with atrial fibrillation.

INTRODUCTION

Dabigatran, as compared with warfarin, was associated with lower rates of stroke and systemic embolism with similar rates of major hemorrhage. But it has a significantly higher risk of gastrointestinal bleeding (GIB). There are limited data on how to prevent GIB from dabigatran and what are the risk factors.

METHODS

We performed a retrospective cohort study of patients with atrial fibrillation who have ever taken dabigatran for thromboprophylaxis from October 2010 to February 2013.

RESULTS

A total of 247 patients were identified. There were 10 (4%) patients who developed GIB (6 (6.5%) in PPI/H2RA users vs 4 (2.6%) in non-PPI/H2RA users;  = .184). History of GIB within 1 year prior to dabigatran initiation and HAS-BLED score ≥3 are independent risk factors for GIB, with odds ratio of 25.14 (95% CI, 2.85-221.47;  < .01) and 5.85 (95% CI, 1.31-26.15;  = .021), respectively.

CONCLUSION

In this real-world cohort, PPI/H2RA use was not associated with reduced GIB events. HAS-BLED score ≥3 and prior history of GIB within 1 year are independent risk factors for GIB among dabigatran users.