Evidence map›Paper›PMID 40694275›Full record

Observational studyAdvances in therapy2025

Bleeding-Related Hospitalizations Among Direct Oral Anticoagulant Users and Nonusers in Medicare Fee-For-Service: Variation in Prevalence, Burden, and Characteristics.

Carol M Bazell, Maggie N Alston, Latha G Ganti, Raymond C Chang, H Andrew Wilsey, Stephanie A Leary, Winston C Fopalan, Christopher W Baugh

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Advances in therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. The first month after direct oral anticoagulants: a window of vulnerability.Research and practice in thrombosis and haemostasis · 2026
    Article
  2. Managing bleeds on anticoagulant therapy: a practical guide for clinicians.European heart journal. Acute cardiovascular care · 2026
    Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Carol M BazellMilliman, Inc., New York, NY, USA.
Maggie N AlstonMilliman, Inc., New York, NY, USA.
Latha G GantiDepartment of Research, Orlando College of Osteopathic Medicine, Winter Garden, FL, USA.
Raymond C ChangUS Medical, Biopharmaceuticals, AstraZeneca, Wilmington, DE, USA.
H Andrew WilseyUS Medical, Biopharmaceuticals, AstraZeneca, Wilmington, DE, USA.
Stephanie A LearyMilliman, Inc., New York, NY, USA.
Winston C FopalanMilliman, Inc., New York, NY, USA. winston.fopalan@milliman.com.
Christopher W BaughDepartment of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionBleeding-related hospitalizations represent a major burden for patients and the US healthcare system. Anticoagulant therapies pose a greater risk for bleeding, especially among the older Medicare population. Direct oral anticoagulants (DOACs) have become the most common type of oral anticoagulant used in Medicare due to their clinical advantages. This descriptive study examines the burden of bleeding-related hospitalizations among DOAC users and nonusers (with no evidence of anticoagulant or antiplatelet use) in Medicare fee-for-service (FFS).

methodsThis was an observational retrospective cohort study of bleeding-related hospitalizations in Medicare FFS using the 2020-2022 Medicare 100% Research Identifiable Files. We used 2020-2021 pharmacy claims to classify beneficiaries into DOAC user and nonuser cohorts and 2021-2022 healthcare administrative claims to identify demographics, bleeding-related hospitalization characteristics, and outcomes.

resultsOf 18.4 million Medicare FFS beneficiaries who met the study's enrollment requirements, 9.3% were assigned to the DOAC user cohort, 81.5% were assigned to the nonuser cohort, and 9.1% were excluded (non-DOAC anticoagulant-only or prescription antiplatelet-only users). The bleeding-related hospitalization rate was four times higher in the DOAC user cohort compared to the nonuser cohort (27.5 and 6.7 per 1000 beneficiaries, respectively). Gastrointestinal bleeding was the most common bleed type leading to hospitalization in both DOAC user and nonuser cohorts (64.6% and 55.4%, respectively), followed by intracerebral hemorrhage (21.3% and 34.5%, respectively), and other types of bleeding (14.2% and 10.1%, respectively). Characteristics and outcomes were similar between cohorts, with variation largely related to bleeding type.

conclusionThis study demonstrated variations in use of DOACs and characteristics of bleeding-related hospitalizations and identified higher rates of bleeding-related hospitalizations among DOAC users compared to nonusers. Hospitalization characteristics and outcomes differed by bleeding type. These findings highlight the Medicare FFS burden of bleeding-related hospitalizations and opportunities for the improved detection and management of bleeding, particularly among DOAC users.

Indexed as

AnticoagulantsFee-for-Service PlansHemorrhageHospitalizationMedicareAdministration, OralAgedAged, 80 and overFemaleHumansMalePrevalenceRetrospective StudiesUnited StatesAnticoagulantsAdministrative claimsBleedingDemographicsDirect oral anticoagulantDOACHospitalizationMedicarePrevalenceRetrospective analysis

Identifiers

PMID40694275
PMCPMC12474692

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.