Bleeding-related hospitalizations represent a major burden for patients and the U.S. healthcare system. Gastrointestinal (GI) bleeding and intracerebral hemorrhage (ICH) are the most common causes of severe bleeding, resulting in a substantial number of hospitalizations and high rates of 30-day readmissions. For example, in the United States in 2018, GI bleeding resulted in about 500,000 hospitalizations with median costs of $32,450 per incident, and 85,000 readmissions at an average of $36,546 each time. 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 in Medicare fee-for-service (FFS). The study results were published in the 22 July 2025 issue of Advances in Therapy.
Key findings:
- Of 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 (27.5 per 1,000 beneficiaries) compared with the nonuser cohort (6.7 per 1,000 beneficiaries).
- GI bleeding was the most common bleed type leading to hospitalization in both DOAC user (64.6%) and nonuser cohorts (55.4%).
- ICH had rates of 21.3% for DOAC users and 34.5% for nonusers.
- Other bleed types leading to hospitalization totaled 14.2% for DOAC users and 10.1% for nonusers.