Comparative risk for intracranial hemorrhage related to new oral anticoagulants: A network meta-analysis.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE

Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins

Antithrombins/*adverse effects ; Aspirin/*adverse effects ; Intracranial Hemorrhages/*epidemiology ; Warfarin/*adverse effects; Administration, Oral ; Antithrombins/administration & dosage ; Aspirin/administration & dosage ; Clinical Trials, Phase III as Topic ; Humans ; Intracranial Hemorrhages/chemically induced ; Mortality ; Network Meta-Analysis ; Randomized Controlled Trials as Topic ; Risk Assessment/statistics & numerical data ; Warfarin/administration & dosage

Background: The intracranial hemorrhage (ICH) risk of oral anticoagulants/non-vitamin K antagonist oral anticoagulants (NOACs) remains largely unknown. Patients who need oral anticoagulants such as aspirin or warfarin often suffer from obvious complications.
Methods: This network meta-analysis intended to assess the ICH risk in patients taking NOACs. The data from PubMed, the Cochrane database, and Embase were reviewed. All phase III randomized controlled trials of NOACs (apixaban, edoxaban, dabigatran, rivaroxaban), aspirin and warfarin were reviewed.
Results: Twenty-three trials involving 137,713 participants were included, involving 6 regimens. Warfarin had the first risk of ICH (surface under the cumulative ranking area: 0.82), followed by dabigatran, edoxaban, aspirin, apixaban, rivaroxaban, and placebo. Dabigatran had the lowest risk of all-cause mortality (surface under the cumulative ranking area: 0.63), followed by apixaban, edoxaban, warfarin, rivaroxaban, aspirin, and placebo.
Conclusion: Warfarin significantly increased the risk of ICH in patients taking oral anticoagulants compared with 4 NOACs (dabigatran, edoxaban, apixaban, rivaroxaban) and aspirin. Apixaban is least likely to induce all-cause mortality.
Competing Interests: The authors have no funding and conflicts of interest to disclose.
(Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

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0 (Antithrombins)
5Q7ZVV76EI (Warfarin)
R16CO5Y76E (Aspirin)

Date Created: 20210325 Date Completed: 20210402 Latest Revision: 20230103

20240829

PMC9281993

10.1097/MD.0000000000024522

33761634