— If you are over age 75, and taking an anticoagulant, the
old standard may be the gold standard, Mayo Clinic researchers
and collaborators have determined.
study released online recently in the BMJ medical journal, a
team of researchers from Mayo Clinic, and other collaborators,
showed that for older patients, particularly individuals
greater than 75 years of age, the risk of gastrointestinal
(GI) bleeding is 3 to 5 times higher when taking newer
anticoagulant medications dabigatran or rivaroxaban compared
to when using warfarin.
the most common reasons people take anticoagulant medication,
which lessens the blood’s tendency to clot, is to reduce
potential or severity of clotting complications in patients
with atrial fibrillation or venous thromboembolism. People
with atrial fibrillation and venous thromboembolism have a
much higher risk of strokes, heart attacks and clots in the
lungs and legs, which can result in disability or death.
anticoagulants lessens the likelihood of stroke and other
clotting complications, but brings a different set of risks,
one of which is excessive bleeding due to reduced ability to
form blood clots. Excessive GI bleeding in particular can
itself be life threatening.
has been in use since the 1950s, and is an effective
anticoagulant. Because it is so powerful and long acting,
users are required to have regular blood tests to monitor the
newer medications dabigatran and rivaroxaban are as effective
as warfarin at preventing blood clots and reducing the risk of
stroke and clotting complications, but do not require the
regular monitoring. This convenience factor has resulted in an
upswing in prescriptions for the newer medications as a
replacement for warfarin.
convenience is not the only factor at play here, say the
new anticoagulants have really been popular with patients who
have previously only had one choice of oral
anticoagulant," says lead author Neena S. Abraham, M.D.,
"They greatly reduce the number of visits to the doctor
for monitoring, and are much more convenient for patients.
However, they may not be the right choice for everyone."
many treatment choices available, doctors and patients may
have difficulty narrowing them down to "the right
choice," experts say. This study helps pinpoint what
appears to be a better choice for older individuals.
our study, by using the real-world, national data available
from the Optum Labs Data Warehouse, we were able to determine
that individuals over age 75 have a much higher risk of GI
bleeds than younger patients, if using dabigatran or
rivaroxaban instead of warfarin," says Dr. Abraham.
"Our findings definitely point toward important
age-related risk that merit consideration when doctors are
making treatment recommendations. "
also saw that for patients under age 65, the newer agents
appear to carry less risk of GI bleeds. At 65 this changes,
and risk begins to increase until it exceeds the GI bleeding
risk with warfarin at age 76 and older."
unique study, looking at adults of all ages who received
anticoagulants, say the researchers, and thus has allowed a
better understanding of the way these new drugs work for a
broader group of people.
study's co-authors include: Sonal Singh, M.B.B.S., and G.
Caleb Alexander, M.D., of Johns Hopkins; Herbert Heien,
Lindsey Haas and Nilay Shah, Ph.D., of Mayo Clinic and Optum
Labs, and William Crown, Ph.D., of Optum Labs.