Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups.

Analysing the site of bleeding, rivaroxaban showed a trend towards increased risk of major upper gastrointestinal bleeding and major lower gastrointestinal bleeding, while dabigatran increased the risk of major lower gastrointestinal bleeding ( Figure 7 ).

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Beyond statistical significance, subgroup analyses suggest that the net benefit of the NOAC seems better than that of warfarin in situations in which quality of oral anticoagulation is poor, given that thromboembolic complications, major bleeding, and mortality may be decreased, as well as in patients with prior stroke or transient ischemic attack, particularly if they have concomitant predictive factors for developing ICB (e.g., leukoaraiosis) [ 64 ], given that the absolute risk reduction in ICB may be significant.

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