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Published on: March 15, 2022
Bleeding Risks With Non-Vitamin K Oral Anticoagulants Versus Single Antiplatelet Therapy : A Systematic Review and
Michael Ke Wang1, Geethan Baskaran2, Ghazal Razeghi3
1Population Health Research Institute; Department of Medicine, McMaster University; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (M.K.W., P.J.D., W.F.M., J.S.H., D.C.).
Background:
In several settings, therapeutic-dose non-vitamin K oral anticoagulants (NOACs) are superior to aspirin for the prevention of arterial and venous thromboembolism.
Purpose:
To estimate differences in bleeding risks between NOACs and single antiplatelet therapy.
Data Sources:
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to June 2024 without language restrictions.
Study Selection:
Randomized controlled trials (RCTs) comparing therapeutic-dose NOACs versus single antiplatelet therapy, with a minimum treatment duration of 3 months.
Data Extraction:
Data extraction was done independently and in duplicate.
Data Synthesis:
Nine RCTs with 26 224 participants were included. All studies used aspirin as antiplatelet therapy. Compared with aspirin, apixaban had similar rates of major bleeding (risk difference [RD], 0.0 percentage point [95% CI, -1.3 to 2.6 percentage points]; 5 trials) and intracranial hemorrhage (RD, -0.2 percentage point [CI, -0.6 to 1.4 percentage points]; 5 trials). Compared with aspirin, dabigatran had similar rates of major bleeding (RD, 0.5 percentage point [CI, -2.1 to 19.6 percentage points]; 2 trials) and intracranial hemorrhage (RD, 0.0 percentage point [CI, -1.1 to 24.5 percentage points]; 2 trials). Compared with aspirin, rivaroxaban had higher rates of major bleeding (RD, 0.9 percentage point [CI, -0.1 to 3.7 percentage points]; 2 trials) and intracranial hemorrhage (RD, 0.3 percentage point [CI, -0.1 to 79.7 percentage points]; 2 trials). The evidence certainty ranged from low to moderate.
Limitation:
Confidence intervals were wide and included the possibility of a null effect.
Conclusion:
In this systematic review of RCTs, rates of major bleeding for therapeutic-dose apixaban and dabigatran were similar to those for low-dose aspirin, whereas rates were higher for rivaroxaban.
Primary Funding Source:
None. (PROSPERO: CRD42024553683).
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