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Journal of Neurology

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01-02-2022 | Dabigatran | Review

Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials

Authors: Tingting Wu, Chenyang Lv, Lishui Wu, Wenjun Chen, Meina Lv, Shaojun Jiang, Jinhua Zhang

Published in: Journal of Neurology | Issue 2/2022

Abstract

Objective

We performed a systematic review and meta-analysis to compare the risk of intracranial hemorrhage (ICH) between direct oral anticoagulants (DOACs) and other antithrombotic drugs in detail across all diseases.

Methods

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs). Heterogeneity was examined using the I² statistic. Risk ratio (RR) and 95% confidence interval (CI) were calculated using random-effects meta-analysis.

Results

Fifty-five RCTs were included in this meta-analysis. Compared with vitamin K antagonists (VKAs), dabigatran reduced the risk of ICH by 60% (RR 0.40; 95% CI 0.28–0.57), apixaban by 57% (RR 0.43; 95% CI 0.31–0.58), edoxaban by 56% (RR 0.44; 95% CI 0.29–0.67) and rivaroxaban by 41% (RR 0.59; 95%CI 0.44–0.80). Compared with low-molecular-weight heparins (LMWHs), apixaban, edoxaban and rivaroxaban had a similar risk of ICH. Compared with aspirin, dabigatran and apixaban had a similar risk of ICH, while rivaroxaban posed an increased risk of ICH (RR 2.12; 95% CI 1.31–3.44). For secondary prevention stroke, DOACs reduced the risk of ICH by 46% compared with warfarin (RR 0.54; 95% CI [0.42–0.70]) and had a similar risk of ICH compared with aspirin.

Conclusion

All DOACs had a lower risk of ICH than VKAs. In terms of the risk of ICH, DOACs were overall as safe as LMWHs, and apixaban and dabigatran were as safe as aspirin, but rivaroxaban was not. For secondary prevention stroke, the risk of ICH with DOACs was overall lower than warfarin and similar to aspirin, but it should be noted that compared with aspirin, rivaroxaban may increase the risk of ICH. This is the first pair-wise meta-analysis that compares the risk of ICH between DOACs and other antithrombotic drugs in detail across all diseases, which may have certain significance for patients with high risk of ICH to choose antithrombotic drugs in clinical practice.

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Title: Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials
Authors: Tingting Wu
Chenyang Lv
Lishui Wu
Wenjun Chen
Meina Lv
Shaojun Jiang
Jinhua Zhang
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Dabigatran
Stroke
Edoxaban
Direct Oral Anticoagulant
Apixaban
Direct Oral Anticoagulant
Rivaroxaban
Published in: Journal of Neurology / Issue 2/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-021-10448-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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