Medscape: Bleeding Rates and Medical Costs of New Oral Anticoagulants (warfarin, dabigatran...)

Bleeding Rates and Medical Costs of New Oral Anticoagulants

April 2, 2012 (Chicago, Illinois) — Firsthand experience with the new oral anticoagulants, coupled with excitement over those yet to be widely in use, has inspired a range of studies examining real-world risk/benefits, as well as the potential costs of replacing warfarin with the new agents.

In a poster session at last week's American College of Cardiology 2012 Scientific Sessions, investigators presented two separate experiences with dabigatran from different US centers--showing very different results--while others presented new cost analyses comparing different oral agents with warfarin.

One US report of patients switched to dabigatran showed a much higher rate of major bleeding than in the RE-LY trial, but a lower rate of dyspepsia, while a second report showed a lower rate of both major and minor bleeding compared with RE-LY trial.


In the first study, researchers led by Dr Valay Parikh (Staten Island University Hospital, NY) reviewed a database from a community anticoagulant clinic with 2200 patients. Of these, 89 had been switched from warfarin to dabigatran 150 mg. They compared data on these 89 patients with patients receiving dabigatran 150 mg in the RE-LY trial and found a far higher rate of major bleeding and lower rate of dyspepsia in the community patients compared with the clinical trial, despite their patients being younger and having a lower CHADS₂ score.
Parikh commented: "This is just an observational study, so we don't know the details of each patient. Maybe there are some other factors that might bias the results, but I think we need more studies to identify patients with a high risk of bleeding."...........