{"id":598,"date":"2011-03-08T18:23:50","date_gmt":"2011-03-08T17:23:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=598"},"modified":"2015-11-12T15:31:48","modified_gmt":"2015-11-12T14:31:48","slug":"apixaban-shows-promise","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2011\/03\/08\/apixaban-shows-promise\/","title":{"rendered":"Apixaban shows promise"},"content":{"rendered":"<p>Warfarin has been the primary treatment to mitigate the increased risk of stroke associated with atrial fibrillation for more than 40 years. However, up to 30% of patients are not suitable candidates for or are unwilling to receive warfarin therapy despite having a high risk of stroke. \u00a0A host of new oral agents are now being developed to replace warfarin and in the AVERROES trial, apixaban, a novel factor Xa inhibitor, was tested in patients unsuitable for warfarin therapy and at increased risk of stroke.<!--more--><\/p>\n<p>In a double-blind double-dummy study conducted at 522 centres in 36 countries, 5599 patients with atrial fibrillation were randomly assigned to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mg per day). \u00a0The primary outcome was the occurrence of stroke or systemic embolism and the primary safety outcome was the occurrence of major bleeding.\u00a0 After a mean follow up of 1.1 years the data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. \u00a0There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (HR with apixaban, 0.45; 95% CI, 0.32 to 0.62; P&lt;0.001). \u00a0The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (HR, 0.79; 95% CI, 0.62 to 1.02; P=0.07). \u00a0The safety profile was also favorable with 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (HR with apixaban, 1.13; 95% CI, 0.74 to 1.75; P=0.57); in the case of intracranial bleeding there were 11 episodes with apixaban and 13 with aspirin.\u00a0 These treatment effects were consistent among important subgroups and in indirect comparisons with previous trial data apixaban appeared to be at least as effective as warfarin although this hypothesis is being formally tested in the ongoing ARISTOTLE trial.<\/p>\n<p>Conclusions:<\/p>\n<p>In this large multicenter study in patients with atrial fibrillation for whom warfarin was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage.<\/p>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Connolly%20SJ%22%5BAuthor%5D\">Connolly SJ<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Eikelboom%20J%22%5BAuthor%5D\">Eikelboom J<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Joyner%20C%22%5BAuthor%5D\">Joyner C<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Diener%20HC%22%5BAuthor%5D\">Diener HC<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Hart%20R%22%5BAuthor%5D\">Hart R<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Golitsyn%20S%22%5BAuthor%5D\">Golitsyn S<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Flaker%20G%22%5BAuthor%5D\">Flaker G<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Avezum%20A%22%5BAuthor%5D\">Avezum A<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Hohnloser%20SH%22%5BAuthor%5D\">Hohnloser SH<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Diaz%20R%22%5BAuthor%5D\">Diaz R<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Talajic%20M%22%5BAuthor%5D\">Talajic M<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Zhu%20J%22%5BAuthor%5D\">Zhu J<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Pais%20P%22%5BAuthor%5D\">Pais P<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Budaj%20A%22%5BAuthor%5D\">Budaj A<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Parkhomenko%20A%22%5BAuthor%5D\">Parkhomenko A<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Jansky%20P%22%5BAuthor%5D\">Jansky P<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Commerford%20P%22%5BAuthor%5D\">Commerford P<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Tan%20RS%22%5BAuthor%5D\">Tan RS<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Sim%20KH%22%5BAuthor%5D\">Sim KH<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Lewis%20BS%22%5BAuthor%5D\">Lewis BS<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Van%20Mieghem%20W%22%5BAuthor%5D\">Van Mieghem W<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Lip%20GY%22%5BAuthor%5D\">Lip GY<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Kim%20JH%22%5BAuthor%5D\">Kim JH<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Lanas-Zanetti%20F%22%5BAuthor%5D\">Lanas-Zanetti F<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Gonzalez-Hermosillo%20A%22%5BAuthor%5D\">Gonzalez-Hermosillo A<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Dans%20AL%22%5BAuthor%5D\">Dans AL<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Munawar%20M%22%5BAuthor%5D\">Munawar M<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22O'Donnell%20M%22%5BAuthor%5D\">O&#8217;Donnell M<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Lawrence%20J%22%5BAuthor%5D\">Lawrence J<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Lewis%20G%22%5BAuthor%5D\">Lewis G<\/a>, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Afzal%20R%22%5BAuthor%5D\">Afzal R<\/a> and <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22Yusuf%20S%22%5BAuthor%5D\">Yusuf S<\/a>; <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=%22the%20AVERROES%20Steering%20Committee%20and%20Investigators%22%5BCorporate%20Author%5D\">the AVERROES Steering Committee and Investigators<\/a>. Apixaban in Patients with Atrial Fibrillation. <a href=\"\/\/localhost\/javascript\/AL_get(this,%2520'jour',%2520'N%2520Engl%2520J%2520Med.')%3B\">N Engl J Med.<\/a> 2011 Feb 10. [Epub ahead of print]<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Warfarin has been the primary treatment to mitigate the increased risk of stroke associated with atrial fibrillation for more than 40 years. However, up to 30% of patients are not suitable candidates for or are unwilling to receive warfarin therapy despite having a high risk of stroke. \u00a0A host of new oral agents are now [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2011\/03\/08\/apixaban-shows-promise\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":47,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[279],"tags":[2120,528,1251],"class_list":["post-598","post","type-post","status-publish","format-standard","hentry","category-general-cardiology","tag-apixaban","tag-atrial-fibrillation","tag-warfarin"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Apixaban shows promise - Heart<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/heart\/2011\/03\/08\/apixaban-shows-promise\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Apixaban shows promise - Heart\" \/>\n<meta property=\"og:description\" content=\"Warfarin has been the primary treatment to mitigate the increased risk of stroke associated with atrial fibrillation for more than 40 years. However, up to 30% of patients are not suitable candidates for or are unwilling to receive warfarin therapy despite having a high risk of stroke. \u00a0A host of new oral agents are now [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/heart\/2011\/03\/08\/apixaban-shows-promise\/\" \/>\n<meta property=\"og:site_name\" content=\"Heart\" \/>\n<meta property=\"article:published_time\" content=\"2011-03-08T17:23:50+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-11-12T14:31:48+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Apixaban shows promise\",\"datePublished\":\"2011-03-08T17:23:50+00:00\",\"dateModified\":\"2015-11-12T14:31:48+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/\"},\"wordCount\":424,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#organization\"},\"keywords\":[\"apixaban\",\"atrial fibrillation\",\"warfarin\"],\"articleSection\":[\"General cardiology\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2011\\\/03\\\/08\\\/apixaban-shows-promise\\\/\",\"name\":\"Apixaban shows promise - 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