Published in JAMA Neurology, a meta-analysis of 5 clinical studies looked at a comparison of non–vitamin K antagonist oral anticoagulants (NOACs) with low-dose aspirin with regard to risk of intracranial hemorrhage in patients without atrial fibrillation.
In this analysis, a rivaroxaban dose of 15 mg to 20 mg daily greatly increased the risk of intracranial hemorrhage compared with aspirin, while lower doses of either rivaroxaban or apixaban did not show an increased risk.
Based on this and other studies, it appears the risk of intracranial hemorrhage may be dose-dependent in NOACs. The patient group that requires further study using these drugs is patients without atrial fibrillation, but with sources of cardiac emboli that have a potential for causing embolic stroke. Perhaps at lower doses the risk of intracranial hemorrhage can be reduced compared with aspirin.