Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials

Wang, Tingting; Lv, Chenyang; Wu, Lishui; Lv, Meina; Jiang, Shaojun; Zhang, Jinhua

doi:10.1007/s00415-021-10448-2

Cited by 24 publications

(33 citation statements)

References 89 publications

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“…Risk factors for ICH include increasing age, hypertension, concomitant antiplatelet drug use, reduced platelet count, cerebral amyloid angiopathy, history of stroke/transient ischemic attack, history of bleeding, and ethnicity (Asian, Latin American, or Black) [ 41 ]. Interestingly, two recent meta-analyses focused on the risk of ICH in patients taking DOACs versus VKAs [ 42 , 43 ]. The first, including 82,404 NVAF patients from 19 RCTs confirmed, in agreement with literature data, an almost 50% reduction in risk of ICH with DOACs compared to VKAs showing that, among the four DOACs, dabigatran 110 mg was associated with the lowest risk of ICH [ 42 ].…”

Section: Risk Of Bleeding Complications Under Different Oral Anticoag...mentioning

confidence: 99%

“…Compared to VKAs, all DOACs reduced the risk of ICH: dabigatran by 60%, apixaban by 57%, edoxaban by 56%, and rivaroxaban by 41%. If only RCTs on secondary stroke prevention in AF were considered, compared to warfarin, DOACs reduced the risk of ICH by 46%, with a risk of ICH similar to aspirin [ 43 ].…”

Section: Risk Of Bleeding Complications Under Different Oral Anticoag...mentioning

confidence: 99%

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Risk and Management of Bleeding Complications with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Venous Thromboembolism: a Narrative Review

et al. 2022

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Atrial fibrillation (AF) and venous thromboembolism (VTE) are highly prevalent conditions with a significant healthcare burden, and represent the main indications for anticoagulation. Direct oral anticoagulants (DOACs) are the first choice treatment of AF/VTE, and have become the most prescribed class of anticoagulants globally, overtaking vitamin K antagonists (VKAs). Compared to VKAs, DOACs have a similar or better efficacy/safety profile, with reduced risk of intracerebral hemorrhage (ICH), while the risk of major bleeding and other bleeding harms may vary depending on the type of DOAC. We have critically reviewed available evidence from randomized controlled trials and observational studies regarding the risk of bleeding complications of DOACs compared to VKAs in patients with AF and VTE. Special patient populations (e.g., elderly, extreme body weights, chronic kidney disease) have specifically been addressed. Management of bleeding complications and possible resumption of anticoagulation, in particular after ICH and gastrointestinal bleeding, are also discussed. Finally, some suggestions are provided to choose the optimal DOAC to minimize adverse events according to individual patient characteristics and bleeding risk.

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Section: Risk Of Bleeding Complications Under Different Oral Anticoag...mentioning

confidence: 99%

Section: Risk Of Bleeding Complications Under Different Oral Anticoag...mentioning

confidence: 99%

Risk and Management of Bleeding Complications with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Venous Thromboembolism: a Narrative Review

et al. 2022

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“…Anticoagulants currently used to treat or prevent thromboembolism directly or indirectly target the active sites of the plasma coagulation proteases thrombin and/or factor Xa (e.g., heparins, fondaparinux, bivalirudin, argatroban, direct oral anticoagulants [DOACs]), or lower the plasma concentrations of the precursors of these enzymes (e.g., vitamin K antagonists). Because thrombin and factor Xa are central to the hemostatic response to injury, these drugs increase a patient's risk for severe bleeding, including life‐threatening intracranial and gastrointestinal hemorrhage 1–4 . This reality has led to development of strategies for preventing or stopping anticoagulant‐associated bleeding based on neutralizing or bypassing the anticoagulant 2,5,6 or, in the case of vitamin K antagonists, reconstituting normal levels of coagulation factors 7,8 …”

Section: Introductionmentioning

confidence: 99%

“…Because thrombin and factor Xa are central to the hemostatic response to injury, these drugs increase a patient's risk for severe bleeding, including life-threatening intracranial and gastrointestinal hemorrhage. [1][2][3][4] This reality has led to development of strategies for preventing or stopping anticoagulant-associated bleeding based on neutralizing or bypassing the anticoagulant 2,5,6 or, in the case of vitamin K antagonists, reconstituting normal levels of coagulation factors. 7,8 There has been substantial interest over the past 2 decades in identifying targets for antithrombotic drugs that play a smaller role in hemostasis than do thrombin and factor Xa.…”

Section: Introductionmentioning

confidence: 99%

A proposal for managing bleeding in patients on therapeutic factor XI(a) inhibitors

Salomon

Gailani

2022

Journal of Thrombosis and Haemostasis

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Several drugs that reduce functional levels of the plasma protease zymogen factor XI (FXI), or that inhibit its activated form (FXIa), are being evaluated as treatments to prevent thrombosis. Based on the observation that individuals with inherited FXI deficiency have a relatively mild bleeding disorder, it is anticipated that therapeutic FXI(a) inhibitors will have a smaller impact on hemostasis than anticoagulants targeting thrombin or factor Xa. However, even if FXI(a) inhibitors are determined to be safer than currently used anticoagulants, some patients on these drugs will experience abnormal bleeding or require emergent surgery. Strategies for dealing with such situations are required. Treatment with antifibrinolytic agents and low doses of recombinant factor VIIa effectively prevent abnormal bleeding in FXI‐deficient patients with alloantibody inhibitors to FXI who undergo surgery. We propose that a similar strategy can be used for patients on therapeutic FXI(a) inhibitors who are bleeding or require invasive procedures.

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“…Die Suche ergab insgesamt 21 spezifische Treffer 4 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 . Davon wurden 5 Studien ausgeschlossen (Gründe: falsche Patientenpopulation 23 , falscher Studientyp 24 , keine klinisch relevanten Ergebnisse 15 22 , kein Einzelpräparat 27 ).…”

Section: Literaturrechercheunclassified

Kurkuma- und Curcuminoid-Behandlung bei Gonarthrose

Bittel

Klose

Langhorst

2022

Zeitschrift für Phytotherapie

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Zusammenfassung Hintergrund Die Kurkumawurzel (Curcuma longa L.) wird traditionell in der ayurvedischen, indischen und chinesischen Medizin verwendet. Aufgrund ihrer entzündungshemmenden Eigenschaften gelten Curcuminoide, insbesondere Curcumin, als die wichtigsten Wirkstoffe der Kurkumawurzel und stehen im Mittelpunkt der Forschung zur Behandlung von Kniearthrose (medizinisch als Gonarthrose bezeichnet). Methodik Um einen systematischen Überblick über den aktuellen Stand der Evidenz in klinischen Studien zur Wirksamkeit und Sicherheit der Kurkuma- und Curcuminoid-Behandlung bei Kniearthrose zu erhalten, wurde eine systematische Literaturrecherche in mehreren Datenbanken und eine Evidenzbewertung nach den AWMF-Leitlinien durchgeführt. Ergebnisse Neun systematische Übersichtsarbeiten mit Meta-Analyse im Suchzeitraum 2012–2021 auf der Basis von insgesamt 16 randomisiert kontrollierten Studien (RCTs) bewerten die orale Mono- und Komplementärtherapie mit Kurkuma und Curcuminoiden bei Kniearthrose. Curcuminoid-haltige Präparate wurden einvernehmlich als sichere und klinisch wirksame Therapieoption zur Verbesserung von Schmerz und Funktion bei Kniearthrose im Vergleich zu Placebo (11 RCTs, n=850) oder ergänzend zur Schmerztherapie mit nicht steroidalen Antirheumatika (NSAR) (5 RCTs, n=747) bewertet. Es sind jedoch qualitativ hochwertige, groß angelegte RCTs erforderlich, um die therapeutische Wirksamkeit und Sicherheit für eine Langzeitbehandlung zu bestätigen. Zudem sind aktuell Kurkumaextrakte in Deutschland nicht als Arzneimittel erhältlich. Schlussfolgerung In Anbetracht der begrenzten und hohen Nebenwirkungsraten der derzeitigen Schmerzbehandlungsoptionen kann eine orale Phytotherapie auf Kurkumabasis für die symptomatische Behandlung von Kniearthrose und als Ergänzung zur Schmerztherapie empfohlen werden.

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Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials

Cited by 24 publications

References 89 publications

Risk and Management of Bleeding Complications with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Venous Thromboembolism: a Narrative Review

Risk and Management of Bleeding Complications with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Venous Thromboembolism: a Narrative Review

A proposal for managing bleeding in patients on therapeutic factor XI(a) inhibitors

Kurkuma- und Curcuminoid-Behandlung bei Gonarthrose

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