S1347 The DOAC Dilemma: Rising GI Bleeding Mortality in the Anticoagulant Era

Introduction: Gastrointestinal (GI) bleeding remains the most unpredictable and deadliest complication, accounting for over 1.5 million healthcare visits and approximately 500,000 hospitalizations annually. Our study aims to assess the temporal trends in GI bleeding-related mortality among older U.S. citizens (>65) by sex, race, census and state over 2 decades, coinciding with the rise in direct oral anticoagulant usage (DOAC). Methods: We utilized CDC WONDER database to determine the age-adjusted mortality rates (AAMR) of GI bleed in the U.S. population from 1999-2020. AAMRs per 100,000 people were extracted. The trends were calculated by the Joinpoint Regression Program, which reported the annual percent changes (APC) and average annual percent change (AAPC) using the Monte Carlo Permutation test. We used the parametric test to estimate a 95% confidence interval. Trend comparison was analyzed by parallelism test, with a P-value < 0.05 indicating statistically significant results. Results: From 1999-2020, 644,424 GI bleeding-related deaths were reported among adults aged ≥65 in the US. AAMR declined from 99 in 1999 to 59.9 in 2012, then rose sharply to 68.6 in 2020. Males consistently exhibited higher AAMRs than women (APC 2018-20: 6.04 vs 5.21). By race, Black adults showed the highest AAMR (81.3), followed by Whites (68.1) and American Indians (60.1). Regionally, the South led in mortality (APC 2018-20: 6.96), compared to the Northeast (-0.27), Midwest (6.25), and West (5.30). California reported the most deaths (60,603), followed by Texas. Joinpoint analysis showed significant trend reversals post-2012 across subgroups. These shifts coincided with DOAC uptake during the same period. While earlier years reflected declining mortality, recent years suggest a potential association between anticoagulant usage and resurgence in GI bleeding-related deaths. Conclusion: This study represents a rare national analysis linking a drug class, DOACs, to shifting mortality trends in GI bleeding among older adults. After a prolonged period of decline, mortality began to rise during the same period in which DOACs use became widespread, notably among Hispanic populations and women. These findings parallel the RHEDAR study, which demonstrated higher GI bleed risk with anticoagulants regardless of their type. These demographic disparities highlight the need for risk-adjusted prescribing and improved healthcare access for patients on anticoagulant therapy.