{"id":6404,"date":"2011-02-10T12:38:49","date_gmt":"2011-02-10T17:38:49","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=6404"},"modified":"2011-07-19T17:44:35","modified_gmt":"2011-07-19T21:44:35","slug":"apixaban-better-than-aspirin-for-stroke-prevention-in-af-patients-unable-to-take-warfarin","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/02\/10\/apixaban-better-than-aspirin-for-stroke-prevention-in-af-patients-unable-to-take-warfarin\/","title":{"rendered":"Apixaban Better Than Aspirin for Stroke Prevention in AF Patients Unable to Take Warfarin"},"content":{"rendered":"<p>A new trial presented at the American Stroke Association&#8217;s International Stroke Conference and <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1007432?query=featured_home\">published online in the <\/a><em><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1007432?query=featured_home\">New England Journal of Medicine<\/a><\/em> demonstrates that the novel factor Xa inhibitor apixaban is better than aspirin for the prevention of stroke in AF patients who are unable to take warfarin. Stuart Connolly and investigators in the\u00a0AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Strokes) trial randomized 5599 AF patients who were deemed by their physicians to be unsuitable for vitamin K antagonist therapy to either apixaban (5 mg twice daily) or aspirin (81-324 mg per day).\u00a0Results of the trial were <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/apixaban-beats-aspirin-for-stroke-prevention-in-af\/\">first presented<\/a> last year at the ESC.<\/p>\n<p>AVERROES was stopped early by the data and safety monitoring committee after they observed &#8220;a clear benefit in favor of apixaban.&#8221; Stroke or systemic embolism, the primary outcome of the trial, occurred in 51 patients receiving apixaban compared to 113 receiving aspirin. Here are the rates per year and hazard ratios of the important endpoints:<\/p>\n<ul>\n<li>Primary outcome: 1.6% per year in the apixaban group versus 3.7% in the aspirin group (HR 0.45; 95% CI 0.32-0.62, p&lt;0.001)<\/li>\n<li>Death: 3.5% per year versus 4.4% (HR 0.79, 95% CI 0.62-1.02, p=0.07)<\/li>\n<li>Major bleeding: 1.4% per year versus 1.2% (HR 1.13, 95% CI 0.74-1.75, p=0.57)<\/li>\n<li>First hospitalization for cardiovascular cause: 12.6% per year versus 15.9% (p&lt;0.001)<\/li>\n<\/ul>\n<p>The authors calculated that treating 1000 patients for 1 year with apixaban instead of aspirin would prevent 21 strokes or systemic emboli, 9 deaths, and 33 hospitalizations for cardiovascular causes, but would cause 2 additional major bleeds.<\/p>\n<p>The AVERROES investigators pointed out that warfarin is not taken by one-third of patients who are considered &#8220;ideal candidates&#8221; for the drug: &#8220;The reluctance of patients to use a vitamin K antagonist is not surprising, given the inconvenience of INR monitoring, the lifestyle changes required, and the real and perceived difficulties associated with warfarin therapy.&#8221;<\/p>\n<p>A separate trial, ARISTOTLE, a direct comparison of warfarin and apixaban in AF, is scheduled to be completed in April of this year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A new trial presented at the American Stroke Association&#8217;s International Stroke Conference and published online in the New England Journal of Medicine demonstrates that the novel factor Xa inhibitor apixaban is better than aspirin for the prevention of stroke in AF patients who are unable to take warfarin. Stuart Connolly and investigators in the\u00a0AVERROES (Apixaban [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,13],"tags":[365,363,342,489],"class_list":["post-6404","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-electrophysiology","tag-af","tag-apixaban","tag-spaf","tag-stroke-prevention"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/6404","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=6404"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/6404\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=6404"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=6404"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=6404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}