Bleeding Incidences in Atrial Fibrillation Patients Treated with Dabigatran, Rivaroxaban, or Warfarin: A Population-Based Study

Randomized controlled trials have indicated similar bleeding rates for dabigatran, rivaroxaban, and warfarin. This study aims to evaluate the real-world incidence of bleeding in patients with atrial fibrillation (AF) initiating treatment with these anticoagulants. Using a comprehensive computerized database, we identified patients who began receiving dabigatran, rivaroxaban, or warfarin over a three-year period. Bleeding events that required hospitalization were meticulously reviewed, and bleeding incidences were calculated per 100 patient-years of treatment. Our study included 18,249 patients: 9,564 (52.4%) on warfarin, 5,976 (32.7%) on dabigatran, and 2,709 (14.8%) on rivaroxaban. The bleeding incidences were 3.9 for warfarin, 4.2 for dabigatran, and 4.1 for rivaroxaban. Intracranial hemorrhage rates were 0.71 for warfarin, 0.4 for dabigatran, and 0.27 for rivaroxaban. Gastrointestinal hemorrhage rates were 1.88 for warfarin, 2.98 for dabigatran, and 2.39 for rivaroxaban. These findings align with RCTs, confirming similar bleeding risks among the three treatments in a real-world setting.