Apixaban better than warfarin in patients with atrial fibrillation

January 01, 0001

Apixaban better than warfarin in patients with atrial fibrillation

Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin. In this randomized, double-blind trial, the authors from multiple countries compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority.

They found: "The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio, 0.79; P<0.001 for noninferiority; P=0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; P=0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; NS)."

The authors concluded: "In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality."

Apixaban was safer and more effective overall.

For the full abstract, click here.

N Engl J Med Published online 28 August 2011 © 2011 to the Massachusetts Medical Society
Apixaban versus Warfarin in Patients with Atrial Fibrillation. Christopher B. Granger, John H. Alexander, John J.V. McMurray, et al. Correspondence to Dr. Granger: [email protected]

Category: K. Circulatory, N. Neurological. Keywords: apixaban, atrial fibrillation, warfarin, stroke, bleeding, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 13 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.