Abstract 10780: New Oral Anticoagulants and the Risk of Intracranial Hemorrhage-Insights From a Traditional and Bayesian Meta-analysis and Mixed-Treatment Comparison of Randomized Trials
Objective: Randomized studies have shown a decreased risk of intracranial hemorrhage (ICH) with use of novel oral anticoagulants (NOACs). We performed a meta-analysis to quantitatively assess the rates of ICH.
Methods: MEDLINE, CENTRAL, CINAHL and EBSCO databases, supplemented with conference abstracts, were searched up to December 1, 2012, with no language restriction. NOACs were pooled to perform a comparison in both traditional ‘Frequentist’ as well as ‘Bayesian’ random effects models using ‘vague’ priors and Markov Chain Monte Carlo simulation with Gibbs sampling, calculating pooled odds ratios (ORs) and associated 95% confidence intervals (CIs); as well as number-needed-to-treat (NNT) and 95% credible intervals (CrIs) for the Bayesian analysis.
Results: 6 studies (dabigatran1, rivaroxaban2, apixaban3) enrolling a total of 57,491 patients were included for analysis. NOACs significantly reduced the risk of ICH against all comparators (OR 0.49, 95% CI 0.36-0.65). All the 3 individual drugs reduced the risk of ICH, with Bayesian indirect comparison analysis not revealing a significant credible difference between the specific medications.
Conclusions: NOACs are uniformly associated with an overall reduced risk of ICH when used for stroke prevention in AF. Any of the currently available NOACs can be considered first line for patients at high risk of ICH.
- © 2013 by American Heart Association, Inc.