Oral factor Xa inhibitors and risk of subdural hematoma
| Autor: | Sumiti Nayar, Ashkan Shoamanesh, Robert G. Hart, Kanjana S Perera, Mukul Sharma, Luciana Catanese, Olga Shestakovska, Kelvin Tsun Wai Ng, John W. Eikelboom, Jackie Bosch |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_mechanism_of_action Factor Xa Inhibitor law.invention 03 medical and health sciences 0302 clinical medicine Rivaroxaban Randomized controlled trial law Internal medicine Hematoma Subdural Intracranial Antithrombotic medicine Humans 030212 general & internal medicine Aged Randomized Controlled Trials as Topic Aspirin business.industry Incidence Odds ratio Middle Aged Atherosclerosis Clinical trial Meta-analysis Female Neurology (clinical) business Platelet Aggregation Inhibitors 030217 neurology & neurosurgery Factor Xa Inhibitors medicine.drug |
| Zdroj: | Neurology. 95:e480-e487 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000009826 |
| Popis: | ObjectiveSubdural hematomas (SDHs) are an uncommon, but important, complication of anticoagulation therapy. We hypothesized that the risks of SDH would be similar during treatment with oral factor Xa inhibitors compared with aspirin.MethodsWe assessed the frequency and the effects of antithrombotic treatments on SDHs in the recent international Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial comparing aspirin 100 mg daily, rivaroxaban 5 mg twice daily, and rivaroxaban 2.5 mg twice daily plus aspirin. A systematic review/meta-analysis of randomized trials comparing oral factor Xa inhibitors vs aspirin on SDH risk was undertaken.ResultsAmong 27,395 COMPASS participants, 28 patients with SDHs were identified (mean age 72 years). SDH-associated mortality was 7%. Incidence was 0.06 per 100 patient-years (11 SDH/17,492 years observation) during the mean 23-month follow-up among aspirin-assigned patients and did not differ significantly between treatments. Three additional randomized controlled trials including 16,177 participants reported a total of 14 SDHs with an incidence ranging from 0.06 to 0.1 per 100 patient-years. Factor Xa inhibitor use was not associated with an increased risk of SDH compared to aspirin (odds ratio, 0.97; 95% confidence interval, 0.52–1.81; I2 = 0%).ConclusionThe frequency of SDH was similar in all 3 treatment arms of the COMPASS trial. The COMPASS trial results markedly increase the available evidence from randomized comparisons of oral factor Xa inhibitors with aspirin regarding SDH. From available, albeit limited, evidence from 4 randomized trials, therapeutic dosages of factor Xa inhibitors do not appear to increase the risk of SDH compared with aspirin.Clinical trial identifier number:NCT01776424. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|