Bleeding Risks With Non–Vitamin K Oral Anticoagulants Versus Single Antiplatelet Therapy : A Systematic Review and Meta-analysis of Randomized Trials
Authors' 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.
Study context
- Population
- Randomized controlled trials comparing therapeutic-dose NOACs versus single antiplatelet therapy, with a minimum treatment duration of 3 months
- Participants
- 26,224 participants9 randomized controlled trials (RCTs)
- Comparison
- Therapeutic-dose NOACs versus single antiplatelet therapy
Further pooled results
- The evidence certainty ranged from low to moderate
Safety
| Outcome | Estimate | |
|---|---|---|
| Major bleedingApixabanvs aspirin5 trials | RD 0.0 percentage point (95% CI −1.3 to 2.6) | |
| Major bleedingDabigatranvs aspirin2 trials | RD 0.5 percentage point (95% CI −2.1 to 19.6) | |
| Major bleedingRivaroxabanvs aspirin2 trials; higher rates with rivaroxaban | RD 0.9 percentage point (95% CI −0.1 to 3.7) | |
| Intracranial hemorrhageApixabanvs aspirin5 trials | RD −0.2 percentage point (CI −0.6 to 1.4) | |
| Intracranial hemorrhageDabigatranvs aspirin2 trials | RD 0.0 percentage point (CI −1.1 to 24.5) | |
| Intracranial hemorrhageRivaroxabanvs aspirin2 trials; higher rates with rivaroxaban | RD 0.3 percentage point (CI −0.1 to 79.7) | |
| −50050100Difference, percentage point (linear scale) |
- Major bleeding: Confidence intervals were wide and included the possibility of a null effect.
Original publication
Bleeding Risks With Non–Vitamin K Oral Anticoagulants Versus Single Antiplatelet Therapy : A Systematic Review and Meta-analysis of Randomized Trials. Ann Intern Med. Published 11 February 2025. doi:10.
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