A large analysis of 127,267 patients with blood clots or atrial fibrillation compared the risk of intracranial hemorrhage (ICH) among different blood thinners. The study looked at four direct oral anticoagulants (DOACs): apixaban, dabigatran, edoxaban, and rivaroxaban, and compared them to Vitamin K Antagonists (VKAs) like warfarin.
All DOACs were associated with a lower risk of ICH than VKAs. Specifically, VKAs had more than double the odds of ICH compared to apixaban (OR 2.40). Rivaroxaban and VKAs also had higher odds of ICH than dabigatran (OR 1.89 and 2.83, respectively) and edoxaban (OR 1.60 and 2.39). VKAs had higher odds than rivaroxaban (OR 1.50).
When ranking safety, dabigatran had the highest probability of being safest (SUCRA 87.6%), followed by apixaban (68.6%), edoxaban (67.5%), rivaroxaban (26.1%), and VKAs (0.2%). However, SUCRA is a ranking tool, not a direct comparison, so these results should be interpreted cautiously.
This analysis combines data from multiple randomized trials, which strengthens the evidence. But it is still an indirect comparison, not a head-to-head trial. Patients should discuss their individual risk factors with their doctor before choosing a blood thinner.