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Apixaban appears superior to warfarin across range of patient risk scores
In patients with nonvalvular atrial fibrillation, apixaban was associated with consistent reductions in stroke or systemic embolism and mortality, compared with warfarin, irrespective of the patient’s risk for stroke or bleeding, according to an analysis of the ARISTOTLE trial.
Results of the secondary analysis, published in The Lancet, suggest that current risk scoring systems for tailoring anticoagulation treatment to individual patients may be less relevant when using apixaban (Eliquis, Bristol-Myers Squibb/Pfizer) for patients with AF who have at least one risk factor for stroke.
The main ARISTOTLE results were presented in 2011. Researchers examined the efficacy and safety of apixaban vs. warfarin in patients with nonvalvular AF and found that apixaban resulted in an additional 21% relative reduction in stroke or systemic embolism, 31% relative reduction in major bleeding and 11% relative reduction in overall mortality.
The new analysis focused on data from 18,201 patients based on stroke and bleeding risk assessment scores (CHADS2, CHADS2-VASc and HAS-BLED). Patients assigned apixaban had reduced stroke or systemic embolism with no significant difference across varying risk scores of stroke or bleeding vs. patients assigned warfarin. Apixaban also was associated with lower rates of major bleeding with no significant difference across patients with varying risk scores of stroke or bleeding.
“The benefits of apixaban are preserved regardless of the risk score used and regardless of the patient risk category,” Renato Lopes, MD, Duke University Medical Center cardiologist, said in a press release. “Importantly, apixaban was safer than warfarin in the overall population and tended to cause less intracranial bleeding in those patients whose risk scores defined them as being at the highest risk of bleeding.
“With new oral anticoagulants, such as apixaban, we might not need risk scores to guide treatment decisions for stroke prevention in patients with AF. This may simplify how physicians make decisions and also improve patient care,” Lopes said.
Disclosure: Funding was received from Bristol-Myers Squibb and Pfizer for this study.