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Similar bleeding rates in patients with VTE and AF treated with DOACs

Presented by
Dr Farès Moustafa, CHU Clermont Ferrand, France
ISTH 2020


A retrospective study from a French emergency department including 525 patients with venous thromboembolic disease (VTE) and atrial fibrillation (AF) found no difference in bleeding risk during therapy with direct oral anticoagulants (DOACs) for these medical conditions [1].

The use of DOACs is an integral part in the management of different indications such as AF and VTE; and, as with any anticoagulation treatment, their use may be associated with the occurrence of haemorrhagic complications. Using information from a database in an emergency department, a retrospective study assessed the incidence of haemorrhage in patients with VTE or AF,

The majority of the 525 included patients were treated with a DOAC (i.e. dabigatran, rivaroxaban, or apixaban) for AF (71.6%), another 149 (28.4%) were treated for VTE. Patients with both VTE and AF were excluded. In total, 95 patients were admitted due to haemorrhage: 27 VTE patients (28.4%) and 68 AF patients (71.6%).

The percentage of haemorrhage was comparable in both indications: 18.4% in the VTE group compared with 18.3% in patients with AF. The AF subgroup was significantly older, had more hypertension, and more strokes (all differences P<0.001) compared with the VTE patients. In addition, they had a higher incidence of myocardial infarction, more associated treatments, and a higher haemorrhagic risk score. Despite these striking differences, a subgroup analysis that compared only those patients with AF with bleedings with VTE patients with bleedings showed that only the age difference persisted (78.6 ± 10.2 years in the group with AF compared with 60.6 ± 21.1 in the VTE group; P<0.001).

The authors concluded that despite the distinct differences between AF and VTE patients with DOACs, those who experience bleedings do not differ except for age. Thus, age should be the main concern with regard to bleeding risk when DOACs are prescribed.

    1. Moustafa F, et al. PB1128, ISTH 2020 Virtual Congress, 12-14 July.


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