Direct Oral Anticoagulants Linked to Fewer Brain Bleeds

 But this suggests otherwise;

The Great Terror of Oral Anticoagulant Use: Intracerebral hemorrhage March 2021 

And this to worry about:

Some Blood Thinners May Increase Heart Attack Risk April 2017

Has your doctor factually analyzed this and given you EXACT REASONS FOR YOUR TREATMENT?

A friend of mine refused to go on the new anticoagulants(circa2008) because of the lack of a reversal drug. Be careful out there.

Direct Oral Anticoagulants Linked to Fewer Brain Bleeds

TOPLINE:

Among patients receiving oral anticoagulants (OACs), the use of direct OACs (DOACs) was associated with lower rates of intracerebral haemorrhage (ICH) than the use of vitamin K antagonists (VKAs), without an increase in the incidence of population‑level ICH over time.

METHODOLOGY:

• Researchers conducted an observational study to examine how changes in prescribing OACs were associated with hospital admissions for OAC-related ICH.
• The study compared two 5‑year cohorts: a pre‑DOAC era (2005-2009), during which all OAC use comprised VKAs, and a transition‑to‑DOAC era (2015-2019), reflecting an increasing uptake of DOACs.
• The analysis included 917 patients from the pre-DOAC era and 1002 patients from the transition-to-DOAC era, all of whom were permanent residents of Southern Finland and admitted with an index event of non‑traumatic ICH confirmed by medical records and brain imaging.
• ICH was attributed to VKA treatment if the international normalised ratio was less than 2.0 on admission, and DOAC-related ICH was confirmed through medical records, ie, patient-/caregiver-confirmed medication use or anti-Xa assay, or electronic medication registry data.
• Population‑level data on dispensed OACs were obtained annually from national pharmacy reimbursement registries.

TAKEAWAY:

• During 2005-2009, 12.5% of ICH events were related to the use of OACs (all associated with VKAs); however, during 2015-2019, 18% of ICH events were related to the use of OACs, of which 27% were related to DOACs. The annual incidence of ICH was 12 per 100,000 inhabitants in both the cohorts.
• During 2015-2019, the annual incidence of ICH was 5.4 per 10,000 DOAC users, representing a 34.2% lower incidence rate than VKA users (P = .011); however, the annual incidence of ICH did not differ significantly between the two cohorts for VKA users.
• After multivariable adjustments, the use of DOACs was associated with a 52.7% lower rate of ICH than the use of VKAs (P < .001).

IN PRACTICE:

"Our findings support the superior safety profile of DOACs compared with VKAs. With less restrictive compensation policies for DOACs, switching from VKAs to DOACs when clinically appropriate should eventually result in fewer OAC patients experiencing ICH," the authors wrote.

SOURCE:

This study was led by Liisa Tomppo, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. It was published online on April 06, 2026, in Annals of Medicine.

LIMITATIONS:

The study was limited to a single tertiary hospital, potentially missing a small number of residents hospitalised elsewhere or highly frail patients admitted to local facilities. Due to the retrospective nature, DOAC treatment adherence was verified from medical and prescription records rather than laboratory tests, introducing potential misclassification. The study lacked data on the dose, duration, and exact indications of DOACs.

Article Key Points

Direct oral anticoagulants (DOACs) are linked to a 52.7% lower rate of intracerebral hemorrhage compared to vitamin K antagonists, suggesting a safer profile for DOACs in preventing brain bleeds.

DISCLOSURES:

This study received support from Boehringer Ingelheim. One author declared receiving a non-significant unrestricted research grant from Boehringer Ingelheim Pharmaceuticals.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.