New oral blood thinners are equally effective in reducing the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and can be considered first-line therapy for patients at high risk for brain bleeds, a review published online Oct. 28 in JAMA Neurology found using two different types of statistical analysis.

Researchers led by Saurav Chatterjee, MD, of Brown University in Providence, R.I., analyzed six studies that assessed the effects of novel oral anticoagulants (NOACs) dabigatran (Pradaxa, Boehringer Ingelheim), rivaroxaban (Xarelto, Bayer) and apixaban (Eliquis, Bristol-Myers Squibb).  They used traditional and Bayesian meta-analysis and a mixed treatment comparison to determine rates of ICH.

These three drugs are FDA-approved to prevent stroke in patients with AF, but “[t]he absolute and relative effectiveness of these 3 NOACs in the prevention of ICH is unknown,” they wrote.

They included six studies with a total of 57,491 patients that compared NOACs with conventional anticoagulants, aspirin or placebo as stroke prevention in AF patients. As endpoints, the authors used ICH and/or hemorrhagic stroke. They also classified ICH occurrence as either intraparenchymal or intraventricular hemorrhages and epidural, subdural or subarachnoid hemorrhages.

All the NOACs significantly decreased the risk of ICH when compared with warfarin. The three NOACs were not significantly different from each other based on Bayesian analysis. The data also revealed that the rate of bleeding was similar with both aspirin and a 110 mg dose of dabigatran.

While the mechanism of action behind the lower rate of ICH with NOACs is not precisely known, the authors argued that their findings are clinically relevant.

“[O]ur analysis suggests that any of the currently available NOACs are reasonable choices when risk of ICH is a consideration,” they wrote.