Rivaroxaban tied to higher bleeding rates vs. low-dose aspirin
Key takeaways:
- Rivaroxaban was linked to higher rates of major bleeding compared with low-dose aspirin.
- Apixaban and dabigatran had similar rates of major bleeding compared with low-dose aspirin.
In a systematic review and meta-analysis of trials of non-vitamin K oral anticoagulants vs. single antiplatelet therapy, rivaroxaban was associated with higher rates of major bleeding compared with low-dose aspirin, researchers reported.
The same was not true for other non-vitamin K oral anticoagulants (NOACs).
“Despite the widespread use of both NOACs and aspirin, uncertainties remain about their comparative bleeding risks,” Michael Ke Wang, MD, clinical scholar of medicine on the faculty of health sciences at McMaster University in Hamilton, Ontario, Canada, and investigator at the Population Health Research Institute, told Healio. “This issue is particularly important because many patients, such as those newly diagnosed with atrial fibrillation, often transition from aspirin to a NOAC. To provide clearer guidance for both patients and clinicians, we conducted a systematic review and meta-analysis of nine clinical trials — including over 26,000 patients — to compare the bleeding risks of NOACs vs. aspirin.”
The analysis included nine trials, all of which compared apixaban (Eliquis, Bristol Myers Squibb/Pfizer), dabigatran (Pradaxa, Boehringer Ingelheim) or rivaroxaban (Xarelto, Janssen/Bayer) with low-dose aspirin, totaling 26,224 participants. Across the trials, mean age ranged from 53 to 77 years and percentage of men ranged from 46% to 67%.
Compared with aspirin, apixaban had similar rates of major bleeding (risk difference, 0 percentage points; 95% CI, –1.3 to 2.6) and intracranial hemorrhage (risk difference, –0.2 percentage points; 95% CI, –0.6 to 1.4), the researchers found.
Dabigatran was also similar to low-dose aspirin in rates of major bleeding (risk difference, 0.5 percentage points; 95% CI, –2.1 to 19.6) and intracranial hemorrhage (risk difference, 0 percentage points; 95% CI, –1.1 to 24.5), Wang and colleagues found.
However, compared with aspirin, rivaroxaban was associated with higher rates of major bleeding (risk difference, 0.9 percentage points; 95% CI, –0.1 to 3.7) and intracranial hemorrhage (risk difference, 0.3 percentage points; 95% CI, –0.1 to 79.7), according to the researchers.
“Our analysis revealed that, among the NOACs, apixaban and dabigatran exhibit risk profiles for major bleeding and intracranial hemorrhage that are comparable to aspirin, whereas rivaroxaban has higher bleeding risks vs. aspirin” Wang told Healio. “For patients transitioning from aspirin to a NOAC, our findings suggest that apixaban and dabigatran may offer a safer bleeding profile compared to rivaroxaban. Nevertheless, individual patient factors and clinical judgment remain paramount in treatment selection.”
A limitation of the study is that confidence intervals were wide, so “clinically important differences between treatments may still exist for some of the outcomes assessed, especially among patients with a higher absolute bleeding risk,” the researchers wrote.
For more information:
Michael Ke Wang, MD, can be reached at 237 Barton St. East, Hamilton, ON L8L 2X2, Canada; email: wangm7@mcmaster.ca.
Collapse
Read more about