P2446 - Evaluating Gastrointestinal Bleeding Risks: A Meta-Analysis Comparing Direct Oral Anticoagulants and Warfarin in Older Adult Patients With Atrial Fibrillation

Hamza Naeem, MD¹, Umar Abdul Rehman Khalid, MD¹, Ahmad Zain, MD², Mohammad Maheer Mubashir, ¹, Abdul Mueed Bangash, MBBS³, Usama Qamar, MD¹, Masood Azhar, MD¹, Rida Ayesha Rafique, MD¹, Ijlal Akbar Ali, MD⁴, Muhammad Umair, MD¹, Muhammad Shehryar, MD¹, Muhammad Bilal Shahid, MBBS¹, Usama Ali, MD¹, Muhammad Abdullah Javed, MD^1
1King Edward Medical University, Lahore, Punjab, Pakistan; ²UChealth Parkview Medical Center, Pueblo, CO; ³Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; ⁴University of Oklahoma College of Medicine, Oklahoma City, OK

Introduction: The recently published randomized trial Frail-AF raised ambiguity regarding the safety of using direct oral anticoagulants (DOACs) over warfarin in older adult patients (≥65) with atrial fibrillation (AF). This meta-analysis aims to evaluate gastrointestinal bleeding, major bleeding, or all-cause mortality in these patients.

Methods: We searched Google Scholar, Scopus, Embase, and Pubmed from inception to June 2024 for relevant publications reporting gastrointestinal bleeding, major bleeding (any bleeding in a critical area or organ), or all-cause mortality. Only studies presenting the clinical outcomes data on older adult patients (≥65) with AF, with patients on either DOACs (Epixaban, Rivaroxaban, or Dabigatran), or warfarin, double-arm studies (randomized controlled trials (RCTs) and retrospective Studies), and those with outcomes given in the form of number-of-events were included. Studies without data on AF, with patient age less than 65 years, or single-arm studies (no comparison group) were excluded. Revman 5.4 was used to analyze the data.

Results: We included 14 studies with a total of 589,262 patients. The pooled risk ratios (RR) with 95% confidence interval for gastrointestinal bleeding was 0.90 [0.67, 1.22], (P = 0.50), for major bleeding, it was 0.75 [0.64, 0.89], (P = 0.0008), for all-cause mortality = 0.68 [0.56, 0.83], (P = 0.0002). DOACs did not significantly reduce the risk of gastrointestinal bleeding compared to warfarin. DOACs demonstrated a statistically significant reduction in major bleeding and all-cause mortality compared to the use of warfarin. In the subgroup sensitivity analysis of only RCTs, the results showed for gastrointestinal bleeding (RR, 1.31 [0.95, 1.79], P=0.1), for major bleeding (RR, 0.98 [0.76, 1.25], P< 0.00001), and all-cause mortality (RR, 0.89 [0.83, 0.96], P=0.001).

Discussion: Our findings indicate that DOACs are a safer and more effective option than warfarin for reducing the risk of major bleeding and all-cause mortality in older adult patients with AF. They do not impact the risk of gastrointestinal bleeding. This meta-analysis demonstrates the efficacy of DOACs, which is encouraging. More RCTs are needed for better interpretation.



Disclosures:


Hamza Naeem, MD¹, Umar Abdul Rehman Khalid, MD¹, Ahmad Zain, MD², Mohammad Maheer Mubashir, ¹, Abdul Mueed Bangash, MBBS³, Usama Qamar, MD¹, Masood Azhar, MD¹, Rida Ayesha Rafique, MD¹, Ijlal Akbar Ali, MD⁴, Muhammad Umair, MD¹, Muhammad Shehryar, MD¹, Muhammad Bilal Shahid, MBBS¹, Usama Ali, MD¹, Muhammad Abdullah Javed, MD¹. P2446 - Evaluating Gastrointestinal Bleeding Risks: A Meta-Analysis Comparing Direct Oral Anticoagulants and Warfarin in Older Adult Patients With Atrial Fibrillation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.