The bleeding costs of intensive vs. less intensive antithrombotic strategies: a meta-regression analysis
Authors' conclusion
With currently used antithrombotic regimens, ASCVD event reduction by more intensive treatment no longer increases risk of intracranial bleeding. Fatal haemorrhage remains a seemingly inevitable cost of ASCVD reduction by antithrombotic treatment intensification, albeit at low absolute risks.
Study context
- Population
- Patients with established atherosclerotic cardiovascular disease (ASCVD) (coronary artery disease, cerebrovascular events, peripheral arterial disease) in trials comparing antithrombotic treatmentspatients in 50 studies, coronary artery disease (63%), cerebrovascular events (28%), peripheral arterial disease (15%)
- Participants
- 357,711 patients
- Comparison
- ASCVD event reduction by intensification of antithrombotic therapy vs bleeding risk
- Outcome
- ASCVD event reduction vs intracranial haemorrhage
Methodological detailsweighted generalized additive regression
- Weighted generalized additive regression
Main finding
As reported in the abstract
- ASCVD event reduction by intensification of antithrombotic therapy correlates with an increased risk of intracranial haemorrhage
Further findings
Reduction in the composite of acute coronary syndrome and stroke vs fatal haemorrhage
- Associated with an increased risk of fatal haemorrhage
Excluding regimens not routinely used in current practice
- Increased risk of intracranial haemorrhage with intensified antithrombotic treatment attenuated to non-significant
- ASCVD event reduction still correlates with an increased risk in fatal haemorrhage
Original publication
The bleeding costs of intensive vs. less intensive antithrombotic strategies: a meta-regression analysis. Eur Heart J Qual Care Clin Outcomes. Published 23 October 2025. doi:10.
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