{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:09:19Z","timestamp":1779170959077,"version":"3.51.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We updated a network meta-analysis of randomized controlled trials to compare the risk of intracranial hemorrhage (ICH) between direct oral anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) in detail across Venous thromboembolism and atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched up to January 5, 2026. The incidence of ICH was investigated. Using frequentist network meta-analysis, interventions that were not compared directly could be compared indirectly by the 95% confidence interval (CI), making the search results more intuitive. Based on surface under the cumulative ranking curves (SUCRA), the relative ranking probability of each group was generated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty randomised controlled trials (127,267 patients) were included. Compared with apixaban, VKAs (OR: 2.40, 95% CI: 1.62\u20133.56) had a higher risk of bleeding, and the difference was significant. Compared with dabigatran, rivaroxaban (OR: 1.89, 95% CI: 1.18\u20133.04) and VKAs (OR: 2.83, 95% CI: 2.00\u20133.99) had a higher risk of bleeding, and the difference was significant. Compared with edoxaban, rivaroxaban (OR: 1.60, 95% CI: 1.04\u20132.47) and VKAs (OR: 2.39; 95% CI: 1.81\u20133.17) had a higher risk of bleeding, and the difference was significant. Compared with rivaroxaban, VKAs (OR: 1.50; 95% CI: 1.08\u20132.07) had a higher risk of bleeding, and the difference was significant. In the ranking of the cumulative probability of ICH, dabigatran (SUCRA 87.6) had the highest safety, followed by apixaban (SUCRA 68.6), edoxaban (SUCRA 67.5), rivaroxaban (SUCRA 26.1), and VKAs (SUCRA 0.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All DOACs had a lower risk of ICH than VKAs. Dabigatran may be the safest choice among any anticoagulant regarding risk of ICH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261336668<\/jats:ext-link>\n                      , identifier CRD420261336668.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1835091","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:42:23Z","timestamp":1779169343000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of intracranial hemorrhage with direct oral anticoagulants: an updated network meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiana","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiaomei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengfu","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"967","DOI":"10.2147\/TCRM.S84210","article-title":"New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events","volume":"11","author":"Mekaj","year":"2015","journal-title":"Ther Clin Risk Manag"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1161\/STROKEAHA.112.650994","article-title":"Intracranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the RE-LY trial","volume":"43","author":"Hart","year":"2012","journal-title":"Stroke"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1136\/heartjnl-2015-307489","article-title":"Non-vitamin K antagonist oral anticoagulants and major bleeding-related fatality in patients with atrial fibrillation and venous thromboembolism: a systematic review and meta-analysis","volume":"101","author":"Caldeira","year":"2015","journal-title":"Heart"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1093\/eurheartj\/ehy802","article-title":"Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials","volume":"40","author":"Wang","year":"2019","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"Br Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. 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