Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 1, pp 22–23 | Cite as

More efficacious, equally safe: a meta-analysis comparing the safety of direct oral anticoagulants versus aspirin

  • Jeffrey Y. Bien
  • Derrick L. Tao
  • Molly M. Daughety
  • Thomas G. DeLoughery
  • Joseph J. Shatzel

Whether aspirin carries a favorable safety profile compared to direct oral anticoagulants (DOACs) remains a topic of controversy. A recent study by Hsu et al. illustrates how providers often preferentially choose aspirin for patients they perceive to be at high risk of bleeding, noting that over 38% of patients who qualify for additional anticoagulation per guidelines are actually managed on aspirin alone in real life practice [1].

Past investigations comparing the safety profile of aspirin against warfarin reveal no observable difference in bleeding events [2]. In turn, DOACs have been shown to be consistently safer than warfarin, with pooled analysis demonstrating decreased rates of total bleeding, major bleeding, and fatal bleeding [3]. However, data directly comparing the safety and efficacy of aspirin against DOACs has been sparse until recently.

The 2017 publication of the EINSTEIN CHOICE trial marked only the second large randomized controlled trial comparing aspirin to...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human and animal participants

No animals were used in this study. This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.School of MedicineOregon Health & Science UniversityPortlandUSA
  3. 3.Division of Hematology and Medical OncologyOregon Health & Science University, Knight Cancer InstitutePortlandUSA

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