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A systematic review and Bayesian network meta‐analysis of risk of intracranial hemorrhage with direct oral anticoagulants
Author(s) -
Wolfe Z.,
Khan S. U.,
Nasir F.,
Raghu Subramanian C.,
Lash B.
Publication year - 2018
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14131
Subject(s) - meta analysis , medicine , bayesian network , intracranial bleeding , computer science , artificial intelligence , anticoagulant
Essentials Risk of intracranial hemorrhage (ICH) may differ between direct oral anticoagulants (DOACs). We compared the risk of ICH between DOACs using network meta‐analysis. Dabigatran 110 mg and 150 mg were safer than rivaroxaban on Bayesian analysis. Dabigatran 110 mg ranked as the safest DOAC while rivaroxaban ranked last.Summary Background The comparative risk of intracranial hemorrhage ( ICH ) among direct oral anticoagulants ( DOAC s) (dabigatran, rivaroxaban, apixaban and edoxaban) remains unclear. Objective To determine the difference in risk of ICH between DOACs Methods Seventeen randomized controlled trials ( RCT s) were selected using PubMed/ MEDLINE , EMBASE and CENTRAL (Inception, 31 December 2017). Estimates were reported as odds ratio ( OR ) with 95% credible interval ( CR .I) in Bayesian network meta‐analysis ( NMA ), and OR with 95% confidence interval ( CI ) in traditional meta‐analyses. Relative ranking probability of each group was generated based on surface under the cumulative ranking curve ( SUCRA ). Results In NMA of 116 618 patients from 17 RCT s (apixaban = 19 495 patients, rivaroxaban = 14 157 patients, dabigatran = 16 074 patients, edoxaban = 11 652 patients, and comparator = 55 315 patients), all DOAC s were safer than warfarin for risk of ICH . Dabigatran 110 mg ranked as the safest drug ( SUCRA , 0.85) and reduced the risk of ICH by 56% compared to rivaroxaban ( OR , 0.44; 95% Cr.I, 0.22–0.82). Pairwise meta‐analysis validated these findings, showing that DOAC s were safer than warfarin ( OR , 0.46; 95% CI , 0.35–0.59). Subgroup analysis showed that the benefit was present when DOAC s were used in non‐valvular atrial fibrillation ( NVAF ) ( OR , 0.51; 95% CI , 0.38–0.68) or venous thromboembolism ( VTE ) ( OR , 0.32; 95% CI , 0.18–0.58). Conclusion Dabigatran 110 mg may be the safest choice among any anticoagulant regarding risk of ICH . Both dabigatran 110 mg and 150 mg were safer than rivaroxaban.