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Apixaban more effective than aspirin in reducing stroke recurrence

Issue: April 2012

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International Stroke Conference 2012

NEW ORLEANS — The oral factor Xa inhibitor apixaban was more effective than aspirin in reducing the risks for stroke and systemic embolism in patients with atrial fibrillation who have already experienced a stroke or transient ischemic attack and are unsuitable for warfarin therapy, researchers reported here.

Results are from the AVERROES study, which included 5,599 patients with AF (mean age, 70 years) at increased risk for stroke. Researchers randomly assigned participants to receive twice-daily apixaban 5 mg (Eliquis, Bristol-Myers Squibb/Pfizer) or daily aspirin 80 mg to 324 mg. Average follow-up was about 1 year.

A subgroup of patients was studied to compare apixaban in patients with (n=764) and without (n=4,832) prior TIA or stroke. Only 10 patients (2.46% per year) with prior stroke and TIA who were assigned to apixaban had recurrent stroke or systemic embolism compared with 33 patients (8.27% per year) assigned to aspirin (HR=0.29; 95% CI, 0.15-0.60). Nine ischemic strokes occurred in the apixaban group (2.21% per year) vs. 27 in the aspirin group (6.27% per year; HR=0.33; 95% CI, 0.15-0.69). Hemorrhagic stroke occurred in only one patient taking apixaban and in four taking aspirin.

Additionally, the mortality rate was higher with aspirin (6.5% vs. 5.3%; HR=0.82; 95% CI, 0.47-1.45).

No significant difference in major bleeds was observed between the two groups.

Overall, these results translate to a number needed to treat (NNT) with apixaban vs. aspirin of 17 in patients with a stroke compared with a NNT of 67 in patients without prior stroke or TIA.

For more information:

• Diener CH. Abstract #3776. Presented at: the American Stroke Association’s International Stroke Conference 2012; Feb. 1-3, 2012; New Orleans.

Disclosure: Dr. Diener has received honoraria and is a consultant/advisory board member for Bristol-Myers Squibb and Pfizer. Dr. Connolly has received research grants and is a consultant/advisory board member for Bristol-Myers Squibb.

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