There is a new systematic review and meta-analysis in the Annals of Internal Medicine that shows how the risks of bleeding are different for non-vitamin K oral anticoagulants (NOACs) and aspirin alone. 

The study, done by McMaster University researchers and colleagues, offers useful information for doctors and patients, particularly those with atrial fibrillation (AF), in recognising the risks associated with various anticoagulant treatments.

The study analysed data from nine randomised controlled trials, which included 26,224 individuals. The primary outcomes were major bleeding and cerebral haemorrhage, with secondary outcomes being fatal, gastrointestinal, clinically relevant nonmajor, and minor bleeding. 

The researchers discovered that therapeutic-dose apixaban and dabigatran had similar rates of severe bleeding and cerebral haemorrhage as low-dose aspirin. However, rivaroxaban had greater rates than aspirin.

The study found that 2.16% of individuals experienced significant bleeding and 0.66% suffered intracranial haemorrhage. The risks of serious bleeding and brain bleeding were about the same with therapeutic-dose apixaban, dabigatran, and aspirin, but they went up with rivaroxaban use.

These findings have important implications for clinical decision-making, particularly in weighing the risks and advantages of prescribing NOACs vs. aspirin for patients with AF. According to the study, apixaban and dabigatran may be safer alternatives to aspirin in terms of bleeding risk; however, rivaroxaban may pose a higher risk. This information can assist clinicians in making more informed decisions, potentially lowering the occurrence of adverse events linked with anticoagulant medication.

In another study published in the Annals of Internal Medicine, Northwestern University researchers assessed the long-term effectiveness of behavioural treatments aimed at minimising over-testing and overtreatment among older persons. The study discovered that the effects of these therapies did not endure in the year following their termination.

The intervention, which included clinical decision support (CDS) through electronic health records, cut down on unnecessary tests and treatments. For example, the number of prostate-specific antigen (PSA) screenings, urine tests given to women for no reason, and diabetes patients given too many hypoglycemic drugs went down. 

However, the benefits did not last once the CDS was removed, implying that ongoing intervention may be required to maintain these gains.

The results of this research emphasise the necessity of evidence-based decision-making in clinical practice. Comparative research on bleeding risks associated with various anticoagulants gives significant insights for managing patients with AF, whereas the evaluation of behavioural therapies emphasises the importance of ongoing efforts to reduce medication misuse. 

These studies, taken together, help to improve our understanding of the risks and advantages of various therapy techniques, with the ultimate goal of better patient outcomes.