Major Bleeding Risk With Antiplatelet Drugs, Anticoagulants for Afib Compared

HealthDay News — The risk of major bleeding is similar for older patients with atrial fibrillation taking either antiplatelet or anticoagulant drugs, according to a review published in the Journal of Thrombosis and Haemostasis.

Marc Melkonian, MD, from the Hôpitaux Universitaires Pitie-Salpêtrière-Charles Foix in France, and colleagues conducted a systematic review and meta-analysis to evaluate major bleeding in randomized and non-randomized controlled trials (RCTs) and parallel cohorts comparing antiplatelet drugs and oral anticoagulants in patients 65 years or older.

Based on 7 RCTs (4,550 patients) and 4 cohort studies (38,649 patients), the researchers found that the risk of major bleeding on aspirin or clopidogrel was equal to that on warfarin in RCTs (relative risk [RR]: 1.01; 95% CI, 0.69-1.48; moderate-quality evidence), lower than on warfarin in non-randomized cohort studies (RR: 0.87; 95% CI, 0.77-0.99; low-quality evidence), and not different when all studies were combined (RR: 0.86; 95% CI, 0.73-1.01). 

Any severity of bleeding (RR: 0.70; 95% CI, 0.57-0.86) and intracranial bleeding (RR: 0.46; 95% CI, 0.30-0.73) were less frequent on antiplatelet drugs than on warfarin. Major bleeding might be higher with warfarin than aspirin in patients over 80 years old, according to subgroup analysis.

“Elderly patients treated with aspirin or clopidogrel suffer less any-severity bleeding but have a risk of major bleeding similar to that of oral anticoagulants, with the exception of intracranial bleeding,” the authors write.

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Melkonian M, Jarzebowski W, Pautas, Siguret V, Belmin J, Lafuente-Laufetne C. Bleeding risk of antiplatelet drugs compared with oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-analysis [published online April 10]. J Thromb Haemost. doi: 10.1111/jth/13697