Key result
Direct oral anticoagulants demonstrated a lower risk of intracranial hemorrhage compared to vitamin K antagonists, with most cases occurring within 5 months in elderly patients.
Why the study?
The study aimed to review and describe post-market cases of oral anticoagulant-induced intracranial hemorrhage to enhance patient safety.
Do DOACs have a lower risk of intracranial hemorrhage compared to VKAs in real-world pharmacovigilance data?
Observational (n=11,201)
Do DOACs have a lower risk of intracranial hemorrhage compared to VKAs in real-world pharmacovigilance data?
Real-world pharmacovigilance data confirms that DOACs have a robustly lower risk of intracranial hemorrhage compared to VKAs, though specific bleeding sites vary by agent.
Background This study aims to review and describe the national post-market cases of oral anticoagulants (OACs)-induced intracranial hemorrhage (ICH) to enhance patient safety.Research design and methods All ICH cases of OACs as primary suspected medicines were extracted from the FAERS. The disproportionality analysis was utilized for signal detection. Subgroup analyses and logistic regression were conducted according to age, sex, weight, hypertension status, concomitant antiplatelet drugs, and indications. Stratification analysis was performed according to the ICH locations.Results In total 11,201 cases of OACs-induced ICH were identified from 2008Q1 to 2024Q1. The median time-to-onset (TTO) and median age for OAC-induced ICHs were 181 days and 75 years, respectively. Most potent positive signal was subdural hemorrhage in rivaroxaban and vitamin K antagonists (VKAs), spinal cord hemorrhage in apixaban, hemorrhagic cerebellar infarction in edoxaban and extra-axial hemorrhage in dabigatran (IC025: 4.04, 5.00, 3.45, 6.09 and 3.51, respectively). After adjusting for confounding factors, lower ICH risks were observed in direct oral anticoagulants (DOACs), compared to VKAs.Conclusion DOACs demonstrated a robust lower risk of ICH compared with VKAs. Different OACs exhibited distinct risk profiles at different ICH sites. The majority of DOACs-induced ICH occurred within 5 months and in elderly patients.
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Chen et al. (2024) conducted an observational in Oral anticoagulants-induced intracranial hemorrhage (n=11,201). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Intracranial hemorrhage risk. Direct oral anticoagulants demonstrated a lower risk of intracranial hemorrhage compared to vitamin K antagonists, with most cases occurring within 5 months in elderly patients.
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