Key result
Warfarin increases intracranial hemorrhage risk ~137% versus apixaban and edoxaban.
Why the study?
The risk of intracranial hemorrhage associated with non-vitamin K antagonist oral anticoagulants remained largely unknown, while patients requiring oral anticoagulation frequently experience complications.
Do NOACs and aspirin reduce the risk of intracranial hemorrhage compared to warfarin in patients requiring oral anticoagulants?
Meta-Analysis (n=137,713)
Do NOACs and aspirin reduce the risk of intracranial hemorrhage compared to warfarin in patients requiring oral anticoagulants?
Effect estimate: OR 2.37 (95% CI 1.71-3.29)
p-value: p=<0.001
This network meta-analysis demonstrates that warfarin is associated with a significantly higher risk of intracranial hemorrhage compared to NOACs and aspirin, supporting the safety profile of NOACs.
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.
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Ma et al. (2021) conducted a meta-analysis in Patients requiring oral anticoagulants (e.g., atrial fibrillation, venous thromboembolism, acute coronary syndrome) (n=137,713). Warfarin vs. Apixaban was evaluated on Intracranial hemorrhage (OR 2.37, 95% CI 1.71-3.29, p=<0.001). Warfarin significantly increased the risk of intracranial hemorrhage compared to apixaban (OR 2.37) and edoxaban (OR 2.46), ranking as the regimen with the highest risk (SUCRA 0.82).
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