Table 1.
The effectiveness and safety of each NOAC as compared to vitamin K antagonists in atrial fibrillation patients at increased age (≥75 years old), multimorbidity, polypharmacy, high falling risk, frailty, and baseline dementia.
| DABIGATRAN | RIVAROXABAN | APIXABAN | EDOXABAN | |||||
|---|---|---|---|---|---|---|---|---|
| ≥75 YEARS OLD | 150 mg | 110 mg | ||||||
| Stroke/systemic embolism (SE) | RCT | ↘ | = | = | ↘ | = | ||
| Obs. | = to ↘ | = to ↘ | = to ↘ | NR | ||||
| Major bleeding | RCT | = | = | = | ↘ | ↘ | ||
| Obs. | = to ↘ | = to ↗ | ↘ | NR | ||||
| Intracranial hemorrhage (ICH) | RCT | ↘ | ↘ | = | ↘ | ↘ | ||
| Obs. | ↘ | = to ↘ | ↘ | NR | ||||
| Gastrointestinal bleeding (GIB) | RCT | ↗ | ↗ | ↗ | NR | ↗ | ||
| Obs. | = to ↗ | = to ↗ | = to ↘ | NR | ||||
| Mortality | RCT | = | = | NR | NR | NR | ||
| Obs. | ↘ | = to ↘ | ↘ | NR | ||||
| MULTIMORBIDITY‡ | 150 mg | 110 mg | 3-5† | ≥6† | ||||
| Stroke/SE | RCT | ↘ | = | = | ↘ | = | = | |
| ↘‡ | ||||||||
| Obs. | = to ↘ | = to ↘ | = to ↘ | NR | ||||
| Major bleeding | RCT | = | = | = | ↘ | = | = | |
| ↘‡ | ||||||||
| Obs. | = | = to ↗ | = | NR | ||||
| ICH | RCT | ↘ | ↘ | NR | NR | NR | ||
| Obs. | = to ↘ | = to ↘ | = to ↘ | NR | ||||
| GIB | RCT | NR | NR | NR | NR | NR | ||
| Obs. | = to ↘ | ↗ | = to ↘ | NR | ||||
| Mortality | RCT | = | = | NR | = | = | NR | |
| Obs. | ↘ | = to ↘ | ↘ | NR | ||||
| POLYPHARMACY | ≥5 drugs | ≥10 drugs | >5 drugs | ≥9 drugs | ||||
| Stroke/SE | RCT | NR | = | = | = | NR | ||
| Obs. | NR | ↘ | = | NR | NR | |||
| Major bleeding | RCT | NR | ↗ | = | ↘ | = | NR | |
| Obs. | NR | = | = | NR | NR | |||
| ICH | RCT | NR | = | ↘ | ↘ | NR | ||
| Obs. | NR | NR | NR | NR | ||||
| GIB | RCT | NR | NR | NR | = | = | NR | |
| Obs. | = | ↗ | ↘ | NR | ||||
| Mortality | RCT | NR | = | = | = | NR | ||
| Obs. | NR | NR | NR | NR | ||||
| HIGH FALLING RISK | ||||||||
| Stroke/SE | RCT | NR | NR | = | = | |||
| Major bleeding | RCT | NR | NR | = | = | |||
| ICH | RCT | NR | NR | ↘ | ↘ | |||
| GIB | RCT | NR | NR | NR | = | |||
| Mortality | RCT | NR | NR | = | = | |||
| FRAILTY | ||||||||
| Stroke/SE | Obs. | = | = | = | NR | |||
| Major bleeding | Obs. | = | = | ↘ | NR | |||
| ICH | Obs. | ↘ | ↘ | = to ↘ | NR | |||
| GIB | Obs. | = | ↗ | = to ↘ | NR | |||
| Mortality | Obs. | NR | NR | NR | NR | |||
| DEMENTIAi | NOACsi | |||||||
| Stroke/SE | Obs. | = | ||||||
| Major bleeding | Obs. | = | ||||||
| ICH | Obs. | ↘ | ||||||
| GIB | Obs. | ↗ | ||||||
| Mortality | Obs. | ↗ | ||||||
= (yellow): non-inferior results (similar risk) when comparing NOAC to VKAs; ↘ (green): superior results (significantly lower risk) when comparing NOAC to VKAs; ↗ (red): inferior results (significantly higher risk) when comparing NOAC to VKAs; = to ↘ (yellow-green): non-inferior to superior results, varying across studies; = to ↗ (yellow-red): non-inferior to inferior results, varying across studies.
†number of baseline comorbidities; ‡high clinical risk score (e.g. CHA2DS2-VASc score ≥3); icareful interpretation of results necessary, as only one observational study provided preliminary (pooled) data.
GIB, gastrointestinal bleeding; ICH, intracranial bleeding; NR, not reported; Obs., longitudinal observational cohort study; RCT, (post hoc analysis of) randomized clinical trial; Stroke/SE, stroke/systemic embolism.