Τίτλος:
Bleeding risk comparison between direct oral anticoagulants at doses
approved for atrial fibrillation and aspirin: systematic review,
meta-analysis and meta-regression
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: A considerable proportion of patients with atrial
fibrillation (AF) are still treated with aspirin despite current
guidelines due to presumed favorable safety.
Aim: We performed a systematic review and meta-analysis of bleeding
outcomes in randomized controlled trials (RCTs) comparing direct oral
anticoagulants (DOACs) at doses approved for AF vs. aspirin.
Methods: We searched PubMed and Scopus for phase-III RCTs of DOACs at
AF-approved doses vs. aspirin. Outcomes assessed were major-,
intracranial-, gastrointestinal-, clinically-relevant-non-majorand fatal
bleeding. We performed two subgroup analyses: one per patient population
i.e. those at high risk of arterial or venous thromboembolism, and one
per DOAC. We also performed a meta-regression to assess the association
with patient age.
Results: In 4 eligible trials (20,440 patients) comparing DOACs vs.
aspirin, the ORs were: 1.52 (95%CI: 0.91-2.53) for major bleeding in
patients at high risk of arterial thromboembolism and 1.55
(95%CI:0.99-2.45, relative-risk-increase:55%,
absolute-risk-increase:0.6%, number-needed-to-harm:170) in the overall
analysis; 1.39 (95%CI:0.62-3.14) for intracranial bleeding in patients
at high risk of arterial thromboembolism which was similar for the
overall analysis; 1.27 (95%CI: 0.84-1.92) for gastrointestinal bleeding
in patients at high risk of arterial thromboembolism and 1.26
(95%CI:0.86-1.85) in the overall analysis. Patient age was not a
predictor of the magnitude of ORs for all bleeding outcomes.
Conclusion: The present meta-analysis does not support the use of
aspirin over DOACs in AF. Accordingly, the level of evidence of the
related recommendations should be upgraded, which in turn may reduce
further the proportion of AF patients treated with antiplatelets.
Συγγραφείς:
Sagris, Dimitrios
Leventis, Ioannis
Georgiopoulos, Georgios and
Korompoki, Eleni
Makaritsis, Konstantinos
Vemmos, Konstantinos
and Milionis, Haralampos
Lip, Gregory Y. H.
Ntaios, George
Περιοδικό:
European Journal of Internal Medicine
Λέξεις-κλειδιά:
Oral anticoagulation; Aspirin; atrial fibrillation; Non-vitamin-K
antagonist oral anticoagulants; Stroke prevention; Bleeding
DOI:
10.1016/j.ejim.2020.05.001
