Key result
Combining aspirin and OAC increases bleeding risk by ~36% versus OAC alone.
Why the study?
Oral anticoagulants (OACs) and aspirin can trigger bleeding events alone or combined, prompting an evaluation of bleeding risk with combination therapy versus either agent alone.
Does the combination of oral anticoagulants and aspirin increase the risk of bleeding compared to either agent alone?
Meta-Analysis
Does the combination of oral anticoagulants and aspirin increase the risk of bleeding compared to either agent alone?
Concomitant use of oral anticoagulants and aspirin significantly increases the risk of bleeding compared to either agent alone, reinforcing the need for careful patient selection when dual therapy is considered.
Answers are grounded in this paper and cite their sources.
Urges careful selection for OAC-aspirin dual therapy to minimize bleeding; confirms elevated risk versus OAC alone across RCTs and observational data.
PURPOSE: Oral anticoagulants (OACs) and aspirin can trigger bleeding events when used alone or in combination. The purpose of this study was to compare the risk of any type of bleeding in individuals exposed to a combination of OAC and aspirin with the risk in those taking an OAC or aspirin alone. METHODS: MEDLINE and Web of Science were queried in January 2021 for eligible articles. Studies were included if they were either randomized controlled trials (RCTs) or observational studies and evaluated the number of any bleeding events in two groups, one with exposure to both OAC and aspirin and one with exposure to OAC alone or aspirin alone. Pooled odds ratios were calculated using a random-effects model. RESULTS: Forty-two studies were included. In an analysis of 15 RCTs and 19 observational studies evaluating OAC plus aspirin versus OAC alone, a significant difference in the risk of bleeding was observed in the combination groups, with an odds ratio [OR] of, 1.36 (95% CI, 1.15-1.59) for RCTs and an OR of 1.42 (95% CI-, 1.09-1.87) for observational studies. When OAC plus aspirin was compared to aspirin alone, a higher rate of bleeding was found in the combination group (OR, 2.36; 95%CI, 1.91-2.92) in the analysis of 15 RCTs, but no significant difference was found among 10 observational studies (OR, 1.93; 95% Cl, 0.99-3.75). CONCLUSION: The risk of any type of bleeding was significantly increased among patients taking aspirin plus OAC compared to those taking OAC alone in both RCTs and observational studies. Evaluation of RCTs comparing OAC plus aspirin to aspirin alone suggests increased bleeding risk as well.
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Ghule et al. (2024) reported a meta-analysis. Oral anticoagulants (OAC) plus aspirin vs. OAC alone or aspirin alone was evaluated on Any type of bleeding (OR 1.36, 95% CI 1.15-1.59). Concomitant use of oral anticoagulants and aspirin significantly increased the risk of any bleeding compared to OAC alone in RCTs (OR 1.36; 95% CI 1.15-1.59) and observational studies.
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