NOACs vs. aspirin: Bleeding risks compared

Study details: This systematic review and meta-analysis included nine randomized controlled trials with 26,224 participants, comparing bleeding risks of non-vitamin K oral anticoagulants (NOACs) - apixaban, dabigatran, and rivaroxaban - with low-dose aspirin.

Results: Apixaban and dabigatran showed similar rates of major bleeding and intracranial hemorrhage compared with aspirin. Specifically, apixaban had no significant difference in major bleeding (0 percentage points; 95% confidence interval [CI], –1.3 to 2.6) or intracranial hemorrhage (–0.2 percentage points; 95% CI, –0.6 to 1.4). Dabigatran also had comparable rates of major bleeding (0.5 percentage points; 95% CI, –2.1 to 19.6) and intracranial hemorrhage (0 percentage points; 95% CI, –1.1 to 24.5). In contrast, rivaroxaban was associated with higher rates of major bleeding (0.9 percentage points; 95% CI, –0.1 to 3.7) and intracranial hemorrhage (0.3 percentage points; 95% CI, –0.1 to 79.7) compared with aspirin.

Clinical impact: While apixaban and dabigatran may offer a safety profile similar to that of aspirin, rivaroxaban's higher bleeding risk necessitates careful consideration, especially in patients at elevated bleeding risk. The findings can guide clinicians in making informed decisions to optimize patient outcomes.

Source:

Wang MK, et al. (2025, February 11). Ann Intern Med. Bleeding Risks With Non-Vitamin K Oral Anticoagulants Versus Single Antiplatelet Therapy : A Systematic Review and Meta-analysis of Randomized Trials. https://pubmed.ncbi.nlm.nih.gov/39928949/