Direct oral anticoagulants (DOACs) are safer than vitamin K antagonists (VKAs) for the prevention of stroke in patients with AFib, according to new data published in The American Journal of Cardiology.
In the analysis, researchers compared the risk of Intracranial Hemorrhage (ICH) between the two options.
They tracked 82,404 patients with AFib and drew data from PubMed, Embase, Web of Science and Cochrane Library databases.
Eighteen-percent of the patients were female, and the median patient age was 70 years old.
The study included anticoagulants: rivaroxaban, dabigatran, apixaban, edoxaban and VKAs.
The authors found that DOACs reduced the ICH risk by almost half compared with VKAs.
In addition, VKAs were the least safe among all oral anticoagulants.
Dabigatran 110 mg was the safest DOAC and rivaroxaban 20 mg was comparatively unsafe.
Compared with rivaroxaban 20 mg, dabigatran 110 mg showed 53% lower relative risk for ICH.
The findings led the team to conclude that, overall, DOACs have less ICH risk vs. VKAs in patients who have AF.
“The strength of our study is that, based on the strict inclusion and exclusion criteria, all included research types are RCTs, and there were more than 80,000 participants,” wrote lead author Meina Lv, BS, with the department of pharmacy, Fujian Medical University Union Hospital, Fuzhou, China, and colleagues. “As far as we know, this was the first comprehensive NMA of the risk of ICH in patients with AF taking different oral anticoagulants.”
The authors noted that the study had several limitations. “First, several DOACs have evidence of only indirect comparison and lack evidence of direct comparison. Second, in our NMA, no specific ICH site was counted, because most of the included studies did not have data in this area.”
Read the full study here.