Stroke in AF

Emma Hitt Nichols

doi:10.1177/1559897715592597

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Figure 1.
Varying Degree of Risk Attributed to Individual Components of CHA₂DS₂-VASc
Relative effects of individual components constituting CHA₂DS₂-VASc score of 1 on ischemic stroke. Horizontal lines represent 95% confident intervals (CIs) around point estimates.
Reprinted from Huang D et al. Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂-VASc Score of 1. Pacing Clin Electrophys. 2014; 37: 1442-1447. Copyright © 1999-2015 John Wiley & Sons, Inc.
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Figure 2.
Meta-analysis of the NOAC Pivotal Trials
Data are n/N, unless otherwise indicated. Heterogeneity: ischaemic stroke I2=32%, p=0.22; haemorrhagic stroke I2=34%, p=0.21; myocardial infarction I2=48%, p=0.13; all-cause mortality I2=0%, p=0.81; intracranial haemorrhage I2=32%, p=0.22; gastrointestinal bleeding I2=74%, p=0.009. NOAC=new oral anticoagulant. RR=risk ratio.
Reprinted from The Lancet, Vol. 383, Ruff CT et al, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, Pages No. 955-962, Copyright (2014), with permission from Elsevier.
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Figure 3.
Guidance for Determining Which NOAC to Prescribe
Possible considerations (authors’ opinions) for selecting between novel oral anticoagulants (if preferred to a vitamin K antagonist) based on patient characteristics in the absence of head-to-head trials. Any clinical decision should take account of individual patient presentation and agent/dose availability based on local regulatory approval. Clinical opinions are often based on indirect comparisons, subgroup analyses, adverse event profiles, and clinical trials in other patient populations. None of these data on which a choice will be made is individually valid, and together only provide a gestalt, but in the absence of other information clinicians have no other way to proceed. Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; CAD, coronary artery disease; GI, gastrointestinal; HAS-BLED, hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, labile international normalized ratio, elderly (≥65 years), drugs/alcohol concomitantly (1 point each); MI, myocardial infarction.
Reprinted from Savelieva I et al. Practical Considerations for Using Novel Oral Anticoagulants in Patients With Atrial Fibrillation. Clin Cardiol. 2013; 37: 32-47. Copyright 2013 Wiley Periodicals, Inc.