Comparative Risk of Gastrointestinal Major Bleeding with Rivaroxaban and Warfarin

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Background: Warfarin has been the primary anticoagulant medication for a long period. However, its efficacy presents clinical challenges, particularly due to the increased risk of bleeding. The introduction of NOACs, such as rivaroxaban, has revolutionized anticoagulation therapy. Nevertheless, evidence regarding their potential side effects has been conflicting. This study aimed to compare the incidence of major bleeding between rivaroxaban and warfarin. Methods: This cohort study was conducted at Ghaem Hospital’s emergency department, involving patients admitted between December 2019 and September 2021 for any reasons. To qualify, the participants were required to have a recorded history of taking warfarin or rivaroxaban for at least one year. The data on major bleeding incidents within the first year of medication usage were collected and then the outcomes were compared between rivaroxaban and warfarin users. Results: A cohort of 402 patients were enrolled in this study, with 203 patients on warfarin and 199 on rivaroxaban. During a one-year follow-up, there were four cases of bleeding in the rivaroxaban group and six in the warfarin group. Upper gastrointestinal bleeding occurred in four patients taking warfarin and one patient taking rivaroxaban, while lower gastrointestinal bleeding was reported in two warfarin users and three rivaroxaban users. Despite these differences, they were not statistically significant (p=0.370), and no patient experienced cerebral hemorrhage. Conclusion: Recommending rivaroxaban might help lower complications and offer a safer treatment option for patients with a history of atrial fibrillation, pulmonary embolism, deep vein thrombosis, or ischemic cerebrovascular accident.

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