{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:11:17Z","timestamp":1789726277809,"version":"4.0.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nRisk factors and comorbidities can complicate management of non-valvular atrial fibrillation. We describe and compare real-world safety and effectiveness of direct oral anticoagulants (DOACs; apixaban, rivaroxaban, dabigatran) and vitamin K antagonists (VKAs) in subgroups of patients with non-valvular atrial fibrillation at high risk for gastrointestinal (GI) bleeding, utilizing data from a national quasi-exhaustive French database.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nAnticoagulant-na\u00efve adults with non-valvular atrial fibrillation with \u22651 gastrointestinal bleeding risk factor, initiating anticoagulant treatment January 2016\u2013December 2019, and covered by the French national health data system were eligible. The following subgroups were evaluated: patients age \u226575 years, receiving concomitant medications, HAS-BLED score \u22653, and chronic kidney disease stage 3\u20134. Outcomes included major bleeding and stroke\/systemic embolism. Patient characteristics were balanced using propensity score matching.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nA total of 314,184 patients were identified; characteristics were similar for propensity score-matched subgroups in VKA\/DOAC and DOAC\/DOAC comparisons. DOACs showed lower risk of major bleeding versus VKAs in all subgroups evaluated (p<\/jats:italic><0.0001 for all). Apixaban showed lower risk of major bleeding and gastrointestinal bleeding versus rivaroxaban in all subgroups (p<\/jats:italic>\u22640.05 for all) and versus dabigatran in elderly patients, patients with HAS-BLED score \u22653, and those receiving concomitant medications (p<\/jats:italic><0.05 for all). Stroke\/systemic embolism risk was lower with apixaban versus rivaroxaban in elderly patients, those with HAS-BLED \u22653, and those receiving concomitant medications; risks were similar for other comparisons.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nDOACs were associated with improved safety and effectiveness when compared to VKAs among subgroups of non-valvular atrial fibrillation patients at high risk of gastrointestinal bleeding. Apixaban was associated with lower risks of major bleeding, gastrointestinal bleeding, and stroke\/systemic embolism versus rivaroxaban as well as lower risk of major bleeding, gastrointestinal bleeding bleed and similar risk of stroke\/systemic embolism versus dabigatran among several of these patient subgroups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317895","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T18:27:02Z","timestamp":1737570422000},"page":"e0317895","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparative safety and effectiveness of oral anticoagulants in key subgroups of patients with non-valvular atrial fibrillation and at high risk of gastrointestinal bleeding: A cohort study based on the French National Health Data System (SNDS)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":true,"given":"Gregory Y. 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