Direct oral anticoagulants (AOD) are prescribed for both atrial fibrillation (AF) and venous thromboembolic disease (VTE). In addition, like any anticoagulant treatment, their use may be associated with the occurrence of haemorrhagic complications. To our knowledge, no study compared hemorrhagic events between these two indications. The objective of our study is to compare these two populations in terms of hemorrhagic incidence and clinical-biological characteristics.

We performed a retrospective and monocentric study from RATED database (NCT02706080) in our emergency department. Major patients under AOD, for AF or VTE, were included. Patients treated for dual MTEV and FA indication were excluded.

Of 525 patients included, 100 patients (19%) were on Dabigatran, 282 (54%) on Rivaroxaban and 143 (27%) on Apixaban with 149 patients (28.4%) treated with VTE and 376 (71.6%) with FA. Of the 95 patients who had hemorrhage, 27 patients (28.4%) were treated for VTE and 68 (71.6%) for AF, or 18.4% hemorrhages in the MTEV group versus 18.3% in the FA group. Patients in the FA group were older (77.4±11.0 vs. 62.8±19.6, P<0.001), had more arterial hypertension (51.9% vs. 33.6%, P<0.001), more stroke (21.1% vs. 8.7%, P<0.001), more myocardial infarction (21.8% vs. 13.1%, P=0.029), more associated treatments (3.7 versus 3, P<0.001), and higher hemorrhagic risk scores. Paradoxically, when analyzing subgroups “AF with haemorrhage” versus “VTE with bleeding”, apart from the persistent age difference (78.6±10.2 versus 60.6±21.1, P<0.001), the medical history became comparable in the two groups.

If patients treated with AOD for AF seem to be different from patients treated for VTE in terms of age or medical histiry, our study showed that during the occurrence of a haemorrhagic event these differences faded, suggesting that patients with bleeding do not differ, regardless of the therapeutic indication.