William French, MD - Anticoagulation: Special Populations - Figure 9

Overall Characteristics of Anticoagulation

Summarizing from clinical trial results to what physicians might expect to see with use of one of the NOACs versus warfarin, or for anticoagulation therapy in general in younger versus older patients, the Figure presents 3 points:

There is a higher absolute rate of stroke and systemic emboli in older patients;
There is a higher absolute rate of major bleeding; and
There is a similar absolute rate of hemorrhagic stroke

(as in the ROCKET AF trial). Overall the relative effects seen in the trials were consistent among the elderly and younger patients for both efficacy and safety – and the net clinical benefit is a very important concept to keep in mind in managing patients with AFib.
The efficacy of treatment with one of the NOACs can be seen in the ARISTOTLE trial in both the younger and older patients, along also with less bleeding risk.[125] So importantly, age should not be a decisive factor in deciding not to treat patients with antithrombin therapy.

French WJ. Am J Med 2013; 126: 00-00.

[ARISTOTLE = Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation]

Complete references for all slides

References

[121] Patel MR, Mahaffey KW, Garg J, et al; the ROCKET AF Steering Committee, for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-891.

[125] Granger CB, Alexander JH, McMurray JV, et al; the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.