Related Experiment Video

Updated: Jun 5, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
09:01

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Published on: October 15, 2021

Risk of intracranial hemorrhage with direct oral anticoagulants: an updated network meta-analysis of randomized

Jiana Chen1, Qiaomei Chen1, Chengfu Guan1

  • 1Department of Pharmacy, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, Fujian, China.

Frontiers in Cardiovascular Medicine
|June 4, 2026
PubMed

Insights

Direct oral anticoagulants (DOACs) show a lower risk of intracranial hemorrhage (ICH) compared to Vitamin K Antagonists (VKAs). Dabigatran emerged as the safest anticoagulant option for reducing ICH risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Intracranial hemorrhage (ICH) is a serious complication of anticoagulant therapy.
  • Direct oral anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) are commonly used for anticoagulation.
  • Comparative risk of ICH between these drug classes requires detailed analysis.

Purpose of the Study:

  • To update a network meta-analysis comparing the risk of ICH between DOACs and VKAs.
  • To evaluate ICH risk across different DOACs and VKAs in patients with venous thromboembolism and atrial fibrillation.

Main Methods:

  • A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library up to January 5, 2026.
  • Frequentist network meta-analysis of 20 randomized controlled trials involving 127,267 patients.
  • Ranking of anticoagulant safety based on Surface Under the Cumulative Ranking Curves (SUCRA) for ICH risk.

Main Results:

  • All DOACs demonstrated a significantly lower risk of ICH compared to VKAs.
  • Specific comparisons showed higher ICH risk with VKAs versus apixaban, dabigatran, edoxaban, and rivaroxaban.
  • Dabigatran ranked highest in safety (SUCRA 87.6), followed by apixaban (68.6), edoxaban (67.5), rivaroxaban (26.1), and VKAs (0.2).

Conclusions:

  • DOACs represent a safer alternative to VKAs regarding the risk of intracranial hemorrhage.
  • Dabigatran appears to be the safest anticoagulant option for minimizing ICH risk.
  • Findings support informed clinical decision-making in anticoagulant selection.
Abstract

Keywords:
atrial fibrillationdirect oral anticoagulantsintracranial hemorrhagenetwork meta-analysisvenous thromboembolism

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