GI bleeding risk associated with simultaneous use of oral glucocorticoids with NOACs: BMJ

Gastrointestinal bleeding (GIB) risk in relation to concomitant treatment with non-vitamin K oral anticoagulants (NOAC) and oral glucocorticoids is insufficiently explored.

A study was conducted by Holt A et. al to investigate the short-term risk following co-exposure of non-vitamin K oral anticoagulants (NOAC) and oral glucocorticoids

The researchers conducted a nationwide Danish study including patients with atrial fibrillation on NOACs during 2012–2018. Patients were defined as exposed to oral glucocorticoids if they claimed a prescription within 60 days prior to Gastrointestinal bleeding (GIB). They investigated the associations between Gastrointestinal bleeding (GIB) and oral glucocorticoid exposure, reporting HRs via a nested case-control design and absolute risk via a cohort design. Matching terms were age, sex, calendar year, follow-up time and non-vitamin K oral anticoagulant (NOAC) agent.

The results of the study are as follows:

• 98,376 patients on non-vitamin K oral anticoagulants (NOACs) were included, and 16% redeemed at least one oral glucocorticoid prescription within 3 years.
• HRs of Gastrointestinal bleeding (GIB) were increased comparing exposed with non-exposed patients.
• 60-day the standardised absolute risk of GIB following first claimed oral glucocorticoid prescription increased compared with non-exposed: 60-day absolute risk: 0.71% vs 0.38%
• The relative risk was elevated as well: risk ratio of 1.89

Thus, the researchers concluded that concomitant treatment with non-vitamin K oral anticoagulants (NOACs) and oral glucocorticoids was associated with a short-term rate and risk increase of Gastrointestinal bleeding (GIB) compared with patients only on non-vitamin K oral anticoagulants (NOACs). This could have implications for clinical management, necessitating closer monitoring or other risk mitigation strategies during episodes of cotreatment with oral glucocorticoids.

Reference:

Gastrointestinal bleeding risk following concomitant treatment with oral glucocorticoids in patients on non-vitamin K oral anticoagulants by Holt A et. al published in the Heart-BMJ journal.

doi: 10.1136/heartjnl-2021-319503