DOACs vs. antiplatelet agents: How do they stack up in terms of intracranial bleeding risk?

December 6, 2024

Study design: This systematic review and meta-analysis examined the risk of intracranial hemorrhage (ICH) associated with DOACs compared with antiplatelet therapy. A total of 9 randomized clinical trials, comprising 45,494 participants, were included.

Results: DOAC therapy wasn't associated with significantly higher odds of ICH compared with antiplatelet therapy (0.55% vs. 0.48% over a mean trial follow-up of 17.1 months; odds ratio [OR], 1.15). Overall, DOAC therapy was associated with higher odds of major hemorrhage compared with antiplatelet therapy (2.41% vs. 1.76% over a mean trial follow-up of 15.5 months; OR, 1.39), with the following estimates by agent: rivaroxaban, OR 1.91; dabigatran, OR 1.21; and apixaban, OR 1.09.

Impact on clinical practice: DOAC therapy wasn't associated with a significantly higher risk of ICH compared with antiplatelet therapy. However, DOAC therapy was associated with a higher risk of major hemorrhage. These findings support the safety of DOACs in terms of intracranial hemorrhage risk and reinforce adherence to current atrial fibrillation guidelines.

Source:

Coyle M, et al. (2024, December 2). JAMA Netw Open. Risk of Intracranial Hemorrhage Associated With Direct Oral Anticoagulation vs Antiplatelet Therapy: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/39630447/