Bleeding events in atrial fibrillation patients treated with Warfarin or NOACs at Chaiyaphum Hospital

Abstract

Atrial fibrillation (AF) is a common heart condition that increases the risk of blood clots, which can lead to stroke, heart attack, and death. Warfarin and Non-vitamin K antagonist oral anticoagulants (NOACs) are medications used to reduce this risk. However, concerns remain regarding the risk of bleeding complications associated with these drugs. This retrospective cohort study investigated the incidence of bleeding complications in patients with AF who were prescribed either Warfarin or NOACs. The study included 2,171 patients with AF who were treated between 2016 and 2023. Data were collected from electronic medical records and analyzed using survival analysis, Kaplan-Meier curves, incidence rate ratios, and incidence differences. Over an 8-year period (2016–2023), the proportions of Warfarin and NOAC use were 85.8% and 14.2%, respectively. The overall incidence of bleeding complications in the study population was 54.8%. The most common bleeding events were hematoma ecchymosis (2.6%) and gum bleeding (2.2%). The incidence of bleeding in the NOAC group was 1.9 per 100 person-years (95% confidence interval (CI) = 1.1-3.2), with no statistically significant difference in bleeding incidence between the two groups. Warfarin had a longer event-free survival time than NOACs (3.61 years; 95% CI = 2.90-4.33). Rivaroxaban, one of the NOACs, was associated with an increased risk of early bleeding. While NOACs had a slightly higher bleeding incidence than Warfarin, they were associated with less severe bleeding events. Warfarin was linked to a wider range of bleeding events, including gastrointestinal and intracranial hemorrhage. NOACs have a slightly higher incidence of bleeding complications than Warfarin, but they cause less severe bleeding events and a narrower range of bleeding types. Therefore, NOACs should be considered as an alternative to Warfarin for patients with a history of Warfarin use. Further research is needed to evaluate the safety and efficacy of individual NOACs, particularly rivaroxaban.