Fernando J Vazquez1, Joaquín P Gonzalez2, Gregoire LeGal3, Marc Carrier3, Esteban Gándara4. 1. Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 2. Hospital Universitario, Universidad Nacional de Cuyo, Mendoza, Argentina. 3. Thrombosis Program, Division of Hematology-Department of Medicine, University of Ottawa-Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada. 4. Thrombosis Program, Division of Hematology-Department of Medicine, University of Ottawa-Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada. Electronic address: egandara@ohri.ca.
Abstract
UNLABELLED: Prior meta-analysis and observational studies have suggested that the bleeding risks associated with anticoagulation using vitamin K antagonists (VKA) or aspirin (ASA) are similar. OBJECTIVE: The aim of this systematic review was to provide the odds ratios (ORs) of major bleeding, intracranial bleeding or major extra-cranial bleeding of anticoagulation with VKA compared to low doses of ASA. METHODS: We conducted a systematic review of Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (RCT). Randomized controlled trials reporting bleeding rates in adult patients randomized to a VKA (INR 2-3) or to ASA alone (<325mg daily). Random effects OR were calculated. RESULTS: Fifteen trials reporting the outcome of 2511 participants treated with VKA alone and 2471 treated with ASA alone were included; most common conditions evaluated were non-valvular atrial fibrillation (five trials) and heart failure (three trials). Overall, the use of VKA was associated with an increased risk of major bleeding (OR 1.76 (95% CI 1.33-2.33) when compared to ASA. The OR associated with VKA use for intracranial bleeding and extra-cranial bleeding were 1.74 (95% CI 0.83-3.62) and 1.66 (95% CI 0.94-2.92), respectively. In trials achieving good control of anticoagulation [time in therapeutic range (TTR) >65%], the risk of bleeding with VKA was similar to that of ASA [OR 1.16 (95% CI 0.79-1.71)]. CONCLUSION: Contrary to prior reports our results suggest that the risk of major bleeding with the use VKA is higher compared to those of patients treated with ASA alone. However, in patients achieving a good TTR, the risk of major bleeding with VKA or ASA is similar.
UNLABELLED: Prior meta-analysis and observational studies have suggested that the bleeding risks associated with anticoagulation using vitamin K antagonists (VKA) or aspirin (ASA) are similar. OBJECTIVE: The aim of this systematic review was to provide the odds ratios (ORs) of major bleeding, intracranial bleeding or major extra-cranial bleeding of anticoagulation with VKA compared to low doses of ASA. METHODS: We conducted a systematic review of Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (RCT). Randomized controlled trials reporting bleeding rates in adult patients randomized to a VKA (INR 2-3) or to ASA alone (<325mg daily). Random effects OR were calculated. RESULTS: Fifteen trials reporting the outcome of 2511 participants treated with VKA alone and 2471 treated with ASA alone were included; most common conditions evaluated were non-valvular atrial fibrillation (five trials) and heart failure (three trials). Overall, the use of VKA was associated with an increased risk of major bleeding (OR 1.76 (95% CI 1.33-2.33) when compared to ASA. The OR associated with VKA use for intracranial bleeding and extra-cranial bleeding were 1.74 (95% CI 0.83-3.62) and 1.66 (95% CI 0.94-2.92), respectively. In trials achieving good control of anticoagulation [time in therapeutic range (TTR) >65%], the risk of bleeding with VKA was similar to that of ASA [OR 1.16 (95% CI 0.79-1.71)]. CONCLUSION: Contrary to prior reports our results suggest that the risk of major bleeding with the use VKA is higher compared to those of patients treated with ASA alone. However, in patients achieving a good TTR, the risk of major bleeding with VKA or ASA is similar.
Authors: Marcus Fernando S Praxedes; Maria Auxiliadora P Martins; Aline O M Mourão; Karina B Gomes; Edna A Reis; Renan P Souza; Emílio Itamar F Campos; Daniel D Ribeiro; Manoel Otávio C Rocha Journal: Eur J Clin Pharmacol Date: 2019-11-12 Impact factor: 2.953
Authors: Francesco Santoro; Thomas Stiermaier; Nicola Tarantino; Luisa De Gennaro; Christian Moeller; Francesca Guastafierro; Maria Francesca Marchetti; Roberta Montisci; Elena Carapelle; Tobias Graf; Pasquale Caldarola; Holger Thiele; Matteo Di Biase; Natale Daniele Brunetti; Ingo Eitel Journal: J Am Heart Assoc Date: 2017-12-04 Impact factor: 5.501
Authors: Christina Christersson; Stefan K James; Lars Lindhagen; Anders Ahlsson; Örjan Friberg; Anders Jeppsson; Elisabeth Ståhle Journal: Heart Date: 2019-11-22 Impact factor: 5.994
Authors: Hassan Mir; Reed Alexander C Siemieniuk; Long Ge; Farid Foroutan; Michael Fralick; Talha Syed; Luciane Cruz Lopes; Ton Kuijpers; Jean-Louis Mas; Per O Vandvik; Thomas Agoritsas; Gordon H Guyatt Journal: BMJ Open Date: 2018-07-25 Impact factor: 2.692