Bleeding Risks With Non-Vitamin K Oral Anticoagulants Versus Single Antiplatelet Therapy : A Systematic Review and Meta-analysis of Randomized Trials.

IF 15.2 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Internal Medicine Pub Date : 2025-03-01 Epub Date: 2025-02-11 DOI:10.7326/ANNALS-24-02132

Michael Ke Wang, Geethan Baskaran, Ghazal Razeghi, Richard Ma, Louis S Park, Manasi Tannu, P J Devereaux, William F McIntyre, Jeff S Healey, Ashkan Shoamanesh, David Conen

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Abstract

Background: In several settings, therapeutic-dose non-vitamin K oral anticoagulants (NOACs) are superior to aspirin for the prevention of arterial and venous thromboembolism.

Purpose: To estimate differences in bleeding risks between NOACs and single antiplatelet therapy.

Data sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to June 2024 without language restrictions.

Study selection: Randomized controlled trials (RCTs) comparing therapeutic-dose NOACs versus single antiplatelet therapy, with a minimum treatment duration of 3 months.

Data extraction: Data extraction was done independently and in duplicate.

Data synthesis: Nine RCTs with 26 224 participants were included. All studies used aspirin as antiplatelet therapy. Compared with aspirin, apixaban had similar rates of major bleeding (risk difference [RD], 0.0 percentage point [95% CI, -1.3 to 2.6 percentage points]; 5 trials) and intracranial hemorrhage (RD, -0.2 percentage point [CI, -0.6 to 1.4 percentage points]; 5 trials). Compared with aspirin, dabigatran had similar rates of major bleeding (RD, 0.5 percentage point [CI, -2.1 to 19.6 percentage points]; 2 trials) and intracranial hemorrhage (RD, 0.0 percentage point [CI, -1.1 to 24.5 percentage points]; 2 trials). Compared with aspirin, rivaroxaban had higher rates of major bleeding (RD, 0.9 percentage point [CI, -0.1 to 3.7 percentage points]; 2 trials) and intracranial hemorrhage (RD, 0.3 percentage point [CI, -0.1 to 79.7 percentage points]; 2 trials). The evidence certainty ranged from low to moderate.

Limitation: Confidence intervals were wide and included the possibility of a null effect.

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.

Primary funding source: None. (PROSPERO: CRD42024553683).

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口服非维生素K抗凝剂与单一抗血小板治疗的出血风险：随机试验的系统评价和荟萃分析

背景：在一些情况下，治疗剂量的非维生素K口服抗凝剂（NOACs）在预防动脉和静脉血栓栓塞方面优于阿司匹林。目的：评价NOACs与单一抗血小板治疗在出血风险方面的差异。数据来源：MEDLINE， Embase， Cochrane Central Register of Controlled Trials和ClinicalTrials.gov，从成立到2024年6月，无语言限制。研究选择：比较治疗剂量NOACs与单一抗血小板治疗的随机对照试验（rct），最小治疗持续时间为3个月。数据提取：数据提取独立完成，一式两份。资料综合：纳入9项随机对照试验，共26 224名受试者。所有的研究都使用阿司匹林作为抗血小板治疗。与阿司匹林相比，阿哌沙班的大出血率相似(风险差异[RD]， 0.0个百分点[95% CI， -1.3至2.6个百分点]；5项试验)和颅内出血(RD, -0.2个百分点[CI， -0.6至1.4个百分点]；5试验)。与阿司匹林相比，达比加群的大出血率相似(RD， 0.5个百分点[CI， -2.1至19.6个百分点]；2项试验)和颅内出血(RD， 0.0个百分点[CI， -1.1至24.5个百分点]；2试验)。与阿司匹林相比，利伐沙班的大出血率更高(RD， 0.9个百分点[CI， -0.1至3.7个百分点]；2项试验)和颅内出血(RD， 0.3个百分点[CI， -0.1至79.7个百分点]；2试验)。证据确定性从低到中等不等。局限性：置信区间很宽，包括零效应的可能性。结论：在这项随机对照试验的系统回顾中，治疗剂量阿哌沙班和达比加群的大出血率与低剂量阿司匹林的大出血率相似，而利伐沙班的大出血率更高。主要资金来源：无。(普洛斯彼罗:CRD42024553683)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.

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