Major and Intracranial Hemorrhage Risk with Direct Oral Anticoagulants vs. Aspirin

A meta-analysis of clinical trials reveals nuances of bleeding with aspirin compared with different DOACs.

Direct oral anticoagulants (DOACs) lead to fewer intracranial hemorrhage (ICH) events compared with warfarin. However, the safety of DOACs as compared with aspirin with regard to ICH and major bleeding remains uncertain, in part because of the small size of individual trials. Now, data are available from a meta-analysis of 9 randomized trials including 45,494 participants who received a DOAC (rivaroxaban, apixaban, or dabigatran) or aspirin.

The incidence of ICH events was similar with DOACs and aspirin — 0.6% and 0.5%, respectively (odds ratio, 1.15), with consistent results for dabigatran (OR, 1.00) and apixaban (OR, 0.74) compared with aspirin, but with elevated risk with rivaroxaban (OR, 2.09).
The incidence of major bleeding was signific…

Reviewing Author

Behnood Bikdeli, MD, MS

Disclosures

Grant/Research SupportBrigham and Women’s Hospital; American Heart Association and VIVA Physicians

Editorial BoardsThrombosis Research; Thrombosis and Haemostasis; Journal of the American College of Cardiology

Leadership Positions in Professional SocietiesSociety for Vascular Medicine (Research, Quality, and Publications Committee member); International Society on Thrombosis and Haemostasis

Behnood Bikdeli, MD, MS

Disclosures

Grant/Research SupportBrigham and Women’s Hospital; American Heart Association and VIVA Physicians

Editorial BoardsThrombosis Research; Thrombosis and Haemostasis; Journal of the American College of Cardiology

Leadership Positions in Professional SocietiesSociety for Vascular Medicine (Research, Quality, and Publications Committee member); International Society on Thrombosis and Haemostasis

Major and Intracranial Hemorrhage Risk with Direct Oral Anticoagulants vs. Aspirin

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Reviewing Author