Association between oral anticoagulant therapy and in-hospital complications and mortality

Lagrave, Juliana; Domingo, Laia; Barceló-Vidal, Jaime; Comas Serrano, Mercè; Jimenez, Carmen; Ferrández, Olivia; Castells, Xavier; Sala i Serra, Maria

doi:http://dx.doi.org/10.1002/bcp.70087

Association between oral anticoagulant therapy and in-hospital complications and mortality

Citation

Lagrave J, Domingo L, Barcelo-Vidal J, Comas M, Jimenez C, Ferrandez O, Castells X, Sala M. Association between oral anticoagulant therapy and in-hospital complications and mortality. Br J Clin Pharmacol. 2025 Sep;91(9):2649-58. DOI: 10.1002/bcp.70087

Abstract

Aims: This study aimed to identify patterns of direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) use in hospitalized patients and to examine their association with in-hospital haemorrhagic complications and mortality. Methods: An observational cross-sectional study was conducted among hospitalized patients ≥18 years from 2018 to 2022. Data on hospital discharges were obtained from the minimum data set and were matched with pharmacy records to identify patients treated with DOACs or VKAs. In-hospital haemorrhagic complications and mortality rates were calculated for study groups. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs), adjusting for age, sex and comorbidities. Analyses were stratified by medical and surgical profiles. Statistical significance was set at .05. Results: The study included 74 190 patients, with 4774 receiving DOACs and 1768 VKAs. During the study period, DOAC use increased by 45.11%. DOAC-treated patients had lower complication rates than those treated with VKAs (1.9 vs. 2.8%, respectively; P = .032). DOAC use was linked to a lower risk of haemorrhagic complications in surgical patients (OR = 0.65; 95%CI: 0.35-0.91), while in medical patients, the reduction in risk was not statistically significant (OR = 0.59; 95%CI: 0.33-1.10). No effect on mortality risk was observed among medical and surgical patients. Conclusions: The increased use of DOACs among hospitalized patients showed a protective effect against haemorrhagic complications in surgical patients, supporting their increasing use in hospital settings.