Key result
Apixaban reduced the risk of stroke or systemic embolism by 21% (HR 0.79) and significantly lowered the risk of major bleeding compared to warfarin in patients with atrial fibrillation.
Why the study?
Does apixaban prevent stroke and systemic embolism in patients with atrial fibrillation compared to warfarin or aspirin?
Systematic Review
Does apixaban prevent stroke and systemic embolism in patients with atrial fibrillation compared to warfarin or aspirin?
Hazard Ratio: 0.79 (95% CI 0.66–0.95)
Absolute Event Rate: 1.27% vs 1.6%
p-value: p=<0.001 for noninferiority, 0.01 for superiority
Apixaban is a highly effective and safe alternative to warfarin and aspirin for stroke prevention in atrial fibrillation, offering reduced mortality and bleeding risks without requiring routine coagulation monitoring.
Supports apixaban as first-line anticoagulation in AF; reinforces consensus from Level 1 evidence synthesis.
Atrial fibrillation (AF) is the most common cardiac arrhythmia which increases the risk of stroke and systemic embolism by 5- fold, it is a major global public health problem. Stroke is associated with greatest mortality and morbidity in patients with AF. Strokes associated with AF are especially large and disabling, and consequently primary prevention is paramount. Antithrombotic therapy is the mainstay of stroke prevention. Vitamin K antagonists (VKA's) have been the standard anticoagulants in stroke prophylaxis for patients with AF for decades. Despite their effectiveness, they are limited by several factors such as narrow therapeutic index, drug- drug interactions, slow onset and offset of action, hemorrhage and routine anticoagulation monitoring to maintain therapeutic international normalized ratio (INR). During recent times, various novel anticoagulants have been developed to expand the therapeutic option for stroke prevention. Apixaban is a novel oral anticoagulant which has been developed and clinically investigated for prevention of stroke in AF patients. This review discusses the pharmacological properties, results of clinical trials investigating role of apixaban for prevention of stroke and its future potential in clinical practice.
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Maan et al. (2012) conducted a systematic review in Atrial Fibrillation. Apixaban vs. Warfarin or Aspirin was evaluated on Stroke or systemic embolism (ARISTOTLE trial) (HR 0.79, 95% CI 0.66-0.95, p=<0.001 for noninferiority, 0.01 for superiority). Apixaban reduced the risk of stroke or systemic embolism by 21% (HR 0.79) and significantly lowered the risk of major bleeding compared to warfarin in patients with atrial fibrillation.
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