Advertisement

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
Article

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...

Notes

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.

References

  1. 1.
    Hsu JC, Maddox TM, Kennedy K et al (2016) Aspirin instead of oral anticoagulant prescription in atrial fibrillation patients at risk for stroke. J Am Coll Cardiol 67:2913–2923.  https://doi.org/10.1016/j.jacc.2016.03.581 CrossRefPubMedGoogle Scholar
  2. 2.
    Mant J, Hobbs FR, Fletcher K et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370:493–503.  https://doi.org/10.1016/S0140-6736(07)61233-1 CrossRefPubMedGoogle Scholar
  3. 3.
    Chai-Adisaksopha C, Crowther M, Isayama T, Lim W (2014) The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood 124:2450–2458.  https://doi.org/10.1182/blood-2014-07-590323 CrossRefPubMedGoogle Scholar
  4. 4.
    Weitz JI, Lensing AWA, Prins MH et al (2017) Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med 376:1211–1222.  https://doi.org/10.1056/NEJMoa1700518 CrossRefPubMedGoogle Scholar
  5. 5.
    Connolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817.  https://doi.org/10.1056/NEJMoa1007432 CrossRefPubMedGoogle Scholar
  6. 6.
    January CT, Wann LS, Alpert JS et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130:2071–2104.  https://doi.org/10.1161/CIR.0000000000000040 CrossRefPubMedGoogle Scholar
  7. 7.
    Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: chest guideline and expert panel report. Chest 149:315–352.  https://doi.org/10.1016/j.chest.2015.11.026 CrossRefPubMedGoogle Scholar

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

Personalised recommendations