Echocardiographic hemodynamics correlate with differences in DOAC-specific bleeding and stroke rates in non-valvular atrial fibrillation.

AIMS: Direct oral anticoagulants (DOACs) are widely used for stroke prevention in people with non-valvular atrial fibrillation/flutter (NVAF).Anticoagulants have different bleeding profiles. Apixaban is associated with the lowest bleeding risk. This study evaluates the interaction between DOAC use and right ventricular systolic pressure (RVSP) on echocardiogram and bleeding rates. It was hypothesized that elevated RVSP may be associated with excess bleeding based on anticoagulant-specific pharmacologic profiles.

METHODS& RESULTS: A retrospective analysis of a database was conducted. Multivariable regression models for bleeding rates were developed using an analysis approach that adjusts for confounders among participants who had undergone an echocardiogram, and interaction terms for DOAC choice were incorporated. Stratum-specific estimates were calculated using linear computation. Patients taking apixaban had lower bleeding rates than those taking rivaroxaban and dabigatran. Among those without elevated RVSP, there was no difference in bleeding rates. Where RVSP was ≥45mmHg, there was a 90% increase in bleeding rates with use of dabigatran (HR 1.99, p=0.024) and rivaroxaban (HR 1.86, p=0.042) compared to apixaban (Table 1D).

CONCLUSIONS: Elevated RVSP is associated with excess bleeding in patients taking rivaroxaban and dabigatran, but not apixaban, after controlling for confounding variables.