ArticleBMJ open2020
Has the introduction of direct oral anticoagulants (DOACs) in England increased emergency admissions for bleeding conditions? A longitudinal ecological study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease-a systematic review and meta-analysis.Journal of nephrology · 2025Pooled it
- Outcomes of guidelines from health technology assessment organizations in community-based primary care: a systematic mixed studies review.International journal of technology assessment in health care · 2024Pooled it
- Systematic review on traumatic intracranial haemorrhage in patients on anti-thrombotic medications; haemorrhage progression, thrombosis, and anti-thrombotic recommencement.Neurosurgical review · 2023Pooled it
- Article
- The Effectiveness of Digital Therapeutics Intervention in Oral Anticoagulation Management: A Systematic Review and Meta-analysis.Mayo Clinic proceedings. Digital health · 2026Article
- Impact of Direct Oral Anticoagulant Uptake on Hospitalizations for Stroke/Transient Ischemic Attack, Intracranial Hemorrhage, and Gastrointestinal Bleeding in Individuals With Atrial Fibrillation: A Population-Based Study.Fundamental & clinical pharmacology · 2025Article
- Evaluating the impact of a structured medication optimisation review on prescribing patterns and bleeding risk among patients prescribed direct oral anticoagulants (DOACs): a difference-in-differences study.BMJ open quality · 2025Article
- Article
- A Year in Review: Atrial Fibrillation 2022.The Journal of innovations in cardiac rhythm management · 2023Article
- Rivaroxaban in acute venous thromboembolism: UK prescribing experience.Research and practice in thrombosis and haemostasis · 2021Article
- Exome-wide association study of bleeding events in patients receiving direct oral anticoagulants.Science progressObservational
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectiveThere is concern about long-term safety of direct oral coagulants (DOACs) in clinical practice. Our aim was to investigate whether the introduction of DOACs compared with vitamin-K antagonists in England was associated with a change in admissions for bleeding or thromboembolic complications.
setting5508 General practitioner (GP) practices in England between 2011 and 2016.
participantsAll GP practices in England with a registered population size of greater than 1000 that had data for all 6 years.
main outcome measureThe rate of emergency admissions to hospital for bleeding or thromboembolism, per 100 000 population for each GP practice in England. MAIN EXPOSURE MEASURE: The annual number of DOAC items prescribed for each GP practice population as a proportion of all anticoagulant items prescribed.
designThis longitudinal ecological study used panel regression models to investigate the association between trends in DOAC prescribing within GP practice populations and trends in emergency admission rates for bleeding and thromboembolic conditions, while controlling for confounders.
resultsFor each additional 10% of DOACs prescribed as a proportion of all anticoagulants, there was a 0.9% increase in bleeding complications (rate ratio 1.008 95% CI 1.003 to 1.013). The introduction of DOACs between 2011 and 2016 was associated with additional 4929 (95% CI 2489 to 7370) emergency admissions for bleeding complications. Increased DOAC prescribing was associated with a slight decline in admission for thromboembolic conditions.
conclusionOur data show that the rapid increase in prescribing of DOACs after changes in National Institute for Health and Care Excellence guidelines in 2014 may have been associated with a higher rate of emergency admissions for bleeding conditions. These consequences need to be considered in assessing the benefits and costs of the widespread use of DOACs.
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