Key result
Warfarin significantly increased the risk of intracranial hemorrhage compared to edoxaban 30 mg (OR 3.42; 95% CI 1.22-7.24) and dabigatran 110 mg (OR 3.56; 95% CI 1.10-8.45) in atrial fibrillation.
Why the study?
Do NOACs alter the risk of gastrointestinal bleeding and intracranial hemorrhage compared to other antithrombotic therapies in patients with atrial fibrillation?
Meta-Analysis (n=91,671)
Do NOACs alter the risk of gastrointestinal bleeding and intracranial hemorrhage compared to other antithrombotic therapies in patients with atrial fibrillation?
Effect estimate: OR 3.42 (95% CI 1.22-7.24)
In patients with non-valvular atrial fibrillation, NOACs do not increase the risks of gastrointestinal bleeding or intracranial hemorrhage compared to each other, with apixaban 5 mg ranking lowest for both risks.
Warfarin raises intracranial hemorrhage risk versus edoxaban 30 mg or dabigatran 110 mg; confirms NOAC safety edge and supports preferential use in atrial fibrillation.
BACKGROUND: Antithrombotic therapy using new oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH), we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. METHODS: We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents (and doses) were treated as separate nodes. Odds ratios (ORs) and 95% confidence intervals (CIs) were modeled using Markov chain Monte Carlo methods. RESULTS: Indirect comparisons with the Bayesian model confirmed that aspirin+clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo (OR 0.33, 95% CI 0.01-0.92). Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg (OR 3.42, 95% CI 1.22-7.24) and dabigatran 110 mg (OR 3.56, 95% CI 1.10-8.45). We further ranked the NOACs for the lowest risk of GIB (apixaban 5 mg) and ICH (apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg). CONCLUSIONS: Bayesian network meta-analysis of treatment of non-valvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.
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Xu et al. (2017) conducted a meta-analysis in atrial fibrillation (n=91,671). New oral anticoagulants (NOACs) vs. Warfarin, antiplatelet drugs, or placebo was evaluated on Intracranial hemorrhage (OR 3.42, 95% CI 1.22-7.24). Warfarin significantly increased the risk of intracranial hemorrhage compared to edoxaban 30 mg (OR 3.42; 95% CI 1.22-7.24) and dabigatran 110 mg (OR 3.56; 95% CI 1.10-8.45) in atrial fibrillation.
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