Anticoagulants for Stroke Prevention in Atrial Fibrillation in Elderly Patients

Fig. 1. Event rates (a) and hazard ratios (or relative risk for dabigatran) (b) for stroke or systemic embolism in patients ≥ 75 years of age in the four trials comparing non-vitamin K oral anticoagulants to vitamin K antagonist for stroke prevention in atrial fibrillation. HR, hazard ratio; NOAC, non-vitamin K oral anticoagulants; RR, relative risk; SSE, stroke or systemic embolism; VKA, vitamin K antagonist. Definition of major bleeding according to study criteria as well as dosing regimens is given for all studies in Table 1

Fig. 2. Event rates (a) and hazard ratios (or relative risk for dabigatran) (b) for major bleedings in patients ≥ 75 years of age in the four trials comparing non-vitamin K oral anticoagulants to vitamin K antagonist for stroke prevention in atrial fibrillation. HR, hazard ratio; NOAC, non-vitamin K oral anticoagulants; RR, relative risk; SSE, stroke or systemic embolism; VKA, vitamin K antagonist. Definition of major bleeding according to study criteria as well as dosing regimens is given for all studies in Table 1

Fig. 3. Event rates (a) and hazard ratios (or relative risk for dabigatran) (b) for gastrointestinal bleeding in patients ≥ 75 years of age in the four trials comparing non-vitamin K oral anticoagulants to vitamin K antagonist for stroke prevention in atrial fibrillation. HR, hazard ratio; NOAC, non-vitamin K oral anticoagulants; RR, relative risk; VKA, vitamin K antagonist. Dosing regimens are given for all studies in Table 1

Fig. 4. Event rates (a) and hazard ratios (or relative risk for dabigatran) (b) for intracranial haemorrhage in patients ≥ 75 years of age in the four trials comparing non-vitamin K oral anticoagulants to vitamin K antagonist for stroke prevention in atrial fibrillation. HR, hazard ratio; NOAC, non-vitamin K oral anticoagulants; RR, relative risk; VKA, vitamin K antagonist. Dosing regimens are given for all studies in Table 1

Fig. 5. Net clinical benefit by NOACs compared with VKA in patients ≥ 75 years of age in the four NOAC approval trials for stroke prevention in atrial fibrillation based on the event rates for stroke or systemic embolism, major bleeding, and intracranial bleeding (ICB) expressed as odds ratios (OR) calculated based on a weighting factor for ICB, the ICB-WF, set at 1.0 for ICB having similar fatality than other events (a), at 1.5 for ICB having 50% higher fatality than other events (b), and at 2.0 for ICB having double the fatality than other events (c) or as number of events prevented/100 patient years of treatment; calculation of the net clinical benefit has been modified according to [18] as explained in the main text. NOAC, non-vitamin K oral anticoagulants; VKA, vitamin K antagonist

Fig. 6. Event rates (a) and hazard ratios (b, c) for stroke or systemic embolism (a, b) and major bleedings (b, c) in patients ≥ 75 years of age in ARISTOTLE and ENGAGE-AF depending on the presence or absence of study-specific dose reduction criteria. HR, hazard ratio; NOAC, non-vitamin K oral anticoagulants; SSE, stroke or systemic embolism; VKA, vitamin K antagonist. Definition of major bleeding according to study criteria as well as dosing regimens is given for all studies in the main text. * indicates a group of patients qualifying for the study-specific dose reduction criteria who were treated with warfarin