Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Am J Cardiol. 2022 Jan 1;162:92-99. doi: 10.1016/j.amjcard.2021.09.011. Epub 2021 Oct 29.
Patients with atrial fibrillation (AF) who take direct oral anticoagulants (DOACs) face the risk of intracranial hemorrhage (ICH), which can be serious and even life threatening, but the risk of ICH of anticoagulants is still controversial. In this meta-analysis, we compared the risk of ICH between vitamin K antagonists (VKAs) and DOACs. Furthermore, we also compared the risk of ICH in different DOACs. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials. The outcome was ICH, shown as the odds ratio (OR) with a 95% confidence interval (CI). DOACs were ranked by calculating the surface under the cumulative ranking curve (SUCRA). We included a total of 82,404 patients with AF. DOACs reduced the ICH risk by nearly half compared with VKAs (OR 0.47, 95% CI 0.40 to 0.54, p <0.001). VKAs were the least safe among all oral anticoagulants (SUCRA 1.7). Dabigatran 110 mg was the safest DOAC (SUCRA 87.3) for ICH risk, whereas rivaroxaban 20 mg was a relatively unsafe DOAC (SUCRA 27.5). Compared with rivaroxaban 20 mg, dabigatran 110 mg presented 53% (OR 0.47, 95% CI 0.27 to 0.82) lower relative risk for ICH. In conclusion, DOACs present less ICH risk than VKAs in patients with AF. For patients with AF who are at high risk of ICH, dabigatran 110 mg may be the safest choice among the DOACs.
患有心房颤动(AF)的患者服用直接口服抗凝剂(DOACs)会面临颅内出血(ICH)的风险,这可能很严重,甚至危及生命,但抗凝剂的 ICH 风险仍存在争议。在这项荟萃分析中,我们比较了维生素 K 拮抗剂(VKAs)和 DOACs 之间 ICH 的风险。此外,我们还比较了不同 DOACs 之间 ICH 的风险。我们检索了 PubMed、Embase、Web of Science 和 Cochrane Library 中的相关随机对照试验。结果以比值比(OR)和 95%置信区间(CI)表示。通过计算累积排序曲线下面积(SUCRA)对 DOACs 进行排序。我们共纳入了 82404 例 AF 患者。与 VKAs 相比,DOACs 降低了近一半的 ICH 风险(OR 0.47,95%CI 0.40 至 0.54,p<0.001)。VKAs 是所有口服抗凝剂中最不安全的(SUCRA 1.7)。达比加群 110mg 是 ICH 风险最安全的 DOAC(SUCRA 87.3),而利伐沙班 20mg 是相对不安全的 DOAC(SUCRA 27.5)。与利伐沙班 20mg 相比,达比加群 110mg 的 ICH 相对风险降低了 53%(OR 0.47,95%CI 0.27 至 0.82)。综上所述,与 VKAs 相比,AF 患者服用 DOACs 可降低 ICH 风险。对于 ICH 风险较高的 AF 患者,达比加群 110mg 可能是 DOACs 中最安全的选择。