SynthesisDrugs in R&D2019
Elderly Bleeding Risk of Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Cohort Studies.
Synthesis in Drugs in R&D, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A systematic review and meta-analysis of the morbidity of efficacy endpoints and bleeding events in elderly and young patients treated with the same dose rivaroxaban.Annals of hematology · 2024Pooled it
- Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews.Drug safety · 2019Pooled it
- Network-Based, Cross-Sectional Analysis of Drug-Related Problems Reveals a Strong Association of Possible Inappropriate Medication and Clinical Outcomes in Romanian Elderly Nursing Home Residents.Medical sciences (Basel, Switzerland) · 2026Article
- Prevalence of Major Bleeding in Elderly Patients on Oral Anticoagulants for Non-Valvular Atrial Fibrillation: A Single-Center 12-Year Retrospective Review.Geriatrics (Basel, Switzerland) · 2025Article
- Article
- Spontaneous Medial Rectus Haematoma: A Sight-Threatening Complication of Warfarin Toxicity.Cureus · 2025Article
- Management of Gastrointestinal Bleeding and Resumption of Oral Anticoagulant Therapy in Patients with Atrial Fibrillation: A Multidisciplinary Discussion.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2023Review
- Personalizing Direct Oral Anticoagulant Therapy for a Diverse Population: Role of Race, Kidney Function, Drug Interactions, and Pharmacogenetics.Clinical pharmacology and therapeutics · 2023Review
- Clinical Characteristics, Patterns of Use, and incidence of Adverse Events in Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants in Colombia.Vascular health and risk management · 2023Article
- Association between Genetic Polymorphisms and Bleeding in Patients on Direct Oral Anticoagulants.Pharmaceutics · 2022Article
- A Comparative Assessment Study of Known Small-molecule GPVI Modulators.ACS medicinal chemistry letters · 2022Article
- Direct Oral Anticoagulant Use in Special Populations: Elderly, Obesity, and Renal Failure.Current cardiology reports · 2021Review
- Clinical factors associated with safety and efficacy in patients receiving direct oral anticoagulants for non-valvular atrial fibrillation.Scientific reports · 2020Article
- Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct.BMJ case reports · 2020Article
- Review
- Therapeutic duplication of anticoagulants: a retrospective study of frequency and consequences in a tertiary referral hospital.Thrombosis journal · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines recommend anticoagulation to reduce clot formation and the risk of thromboembolic events in patients with atrial fibrillation but does not specify guidelines for the elderly population. Direct oral anticoagulants (DOACs) are newer US FDA-approved alternatives to warfarin and include dabigatran, rivaroxaban, apixaban and edoxaban. The efficacy of DOACs is heavily researched, but few studies have evaluated their bleeding risk.
objectivesThis systematic review and meta-analysis investigates which DOAC has the lowest bleeding risk in elderly patients with nonvalvular atrial fibrillation (NVAF).
methodsCINAHL and MEDLINE databases were searched using specific keywords, and 244 results were identified and screened. Inclusion criteria required a major bleeding event requiring hospitalization as an outcome and excluded patients with severe renal failure. Articles that met inclusion criteria were assessed for risk of bias using the Cochrane Tool to Assess Risk of Bias in Cohort Studies. Review Manager (version 5) was used to perform the random-effects model meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. P < 0.05 was considered statistically significant.
resultsSix articles met inclusion criteria and encompassed 446,042 patients in total. Apixaban and dabigatran had statistically significant risk reductions compared with warfarin, whereas rivaroxaban did not (HR 0.60 [95% CI 0.52-0.69], p < 0.00001; HR 0.79 [95% CI 0.70-0.90], p = 0.0005; HR 1.03 [95% CI 0.86-1.22], p = 0.77, respectively.) Data regarding edoxaban were limited and thus not included in the analysis.
conclusionApixaban and dabigatran have a significantly decreased major bleeding risk (40 and 21%, respectively) compared with warfarin. There was no statistical difference in bleeding risk between rivaroxaban and warfarin. Head-to-head prospective randomized controlled trials are required to assess the true bleeding risk of each DOAC.
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Registered trials
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