Q1. What do the terms ‘absolute risk’ (AR) and ‘relative risk’ (RR) mean? Q2. Wh
ID: 3312875 • Letter: Q
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Q1. What do the terms ‘absolute risk’ (AR) and ‘relative risk’ (RR) mean?
Q2. What is the absolute risk for stroke among warfarin users based on the meta-analysis in this table?
Q3. What is the effect of the use of warfarin (as compared to no treatment) on stroke based on the meta-analysis in this table?
Q4. What does the 95% confidence interval for the relative risk of stroke for warfarin relative to no treatment or placebo (0.26-0.51) mean? Q5. What is the relative risk of a major bleeding event from warfarin as compared to no treatment or placebo?
Q6. What is the absolute risk increase (ARI) for bleed among Rivaroxaban users as compared to warfarin?
Q7. Which intervention is most effective in reducing the risk of stroke?
Q8. Which intervention has the greatest effect for a major bleed (relative to no treatment)?
Q9. Given the choice between Rivaroxaban and Apixaban as antithrombotic therapy over warfarin which would you recommend for treating patients at risk for stroke?
Table I Relative risks of stroke and major bleeding of antithrombotic therapies RR of bleed relative to no Study Intervention Control RR of stroke relative to no treatment AR of bleed intervention (%)year) AR of bleed control (%/year) RR of bleed (95% CI) relative to control AR of stroke intervention AR of stroke control (%)year) RR of stroke (95% CI) relative to lyear) control Meta-analysis ASA No treatment or 5.22 6.33 0.78 (0.61-0.98) 0.78 NIA N/A .06 (0.48-1.98) 106 placebo Meta-analysis Warfarin No treatment or 221 6.03 0.36 (0.26-0.51) 0.36 NA N/A 2.30 (1.08-4.89) 2.30 placebo ACTIVE-W ASA+clopidogrel Warfarin RE-LY RE-LY ARISTOTLE Apixaban ROCKET-AF Rivaroxaban Dabigatran 110 Warfarin Dabigatran 150 Warfarin Warfarin Warfarin 2.39 1.44 1.01 1.27 2.12 1.40 1.57 1.57 1.60 2.42 1.72 (1.24-2.37) 0.62 0.92 (0.74-1.13) 0.33 0.64 (0.51-0.81) 0.23 0.79 (0.65-0.95) 028 0.88 (0.75-1.03) 0.32 2.42 2.71 3.11 2.13 3.60 2.21 3.36 3.36 3.09 3.45 .10 (083-1.45) 2.53 0.80 (0.69-0.93) 184 0.93 (0.81-1.07) 2.14 0.69 (0.60-0.80) 159 04 (0.90-1.20) 2.39 AR, absolute risk: RR, relative risk; Bleed, major bleeding event. The 'RR of stroke relative to no treatment values for newer agents (not ASA or warfarin) are calculated by multiplying the 'RR of stroke relative to control' by the RR of the control (warfarin) relative to no treatment or placebo (0.36). Similartly, the 'RR of bleed relative to no treatment values for newer agents are calculated by multiplying the 'RR of bleed relative to control by the RR of bleed of the control option (warfarin) relative to no treatment or placebo (2.30 The RR of stroke relative to no treatment and the RR of bleed relative to no treatment are used by the decision aid to cakculate patients' risks of stroke and bleed with each treatmentExplanation / Answer
1>
AR:- Absolute Risk implies :- The % of Fatalities in terms of Death, Major Bleed that happens measured as %of people suffering stoke/Year
RR:- Relative Risk :- It implies Relative risk when compared with Absolute Risk
2> THe absolute risk amomng Warfarin users is average of AR for all Warfain (Inetrvention+ Control)= 1.765%/Year
3> The use Warfarin reduces the RR of Stroke with no Treatment by Half
Avg RR of stroke relative to no Treatment with usage of Warfarin is 0.35 as compared to RR of stroke Relative to no treatment which is as high as 0.78
4> 95% confidence interval for relative risk of stroke for Warfarin relative to No treatment or Placebo implies
That with usage of Warfarin Intervention and no further treatment given the relative risk of stroke is on an avg 0.36 and given 95 /100 tiemes this avg would be 0.26-0.51
5> Relative Risk of a Major bleeding event from usage of Warfarin 2.01 times as compared to No treatment or Placebo
6> ARI Increase for Bleed among Rivaroxaban Users When compared to Warfarin users = 3.6-2.42= 1.18
7> Based on the data of AR of stroke is the least with the use of Intervention Dabigatran 150
8> Rivaroxaban has the greatest effect for a Major bleed
9> Given a choice between Rivaroxaban and Apixaban . I'll recommend Apixaban as antithrombotic therapy given AR & RR for Major Bleed with ( Control, No Treatment ) is least among the two
End of Answer
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