Apixaban scores the triple whamy

Apixaban prevents embolic stroke, improves mortality, and reduces bleeding when compared to warfarin. Now we have many options for preventing thromboembolic events in atrial fibrillation; warfarin, dabigatran (pradaxa), rivoroxaban, apixaban.

The growing list of oral anticoagulant drugs jockeying to replace warfarin as the go-to agent for stroke prevention in patients with atrial fibrillation added a new candidate, apixaban, that appeared to immediately take the lead on the strength of strikingly impressive results in an 18,000-patient trial.

When matched against warfarin, atrial fibrillation (AF) patients treated with apixaban (Bristol-Myers Squibb, Pfizer) had significantly lower rates of stroke and systemic embolism, major bleeding complication, and overall mortality, compared with patients randomized to warfarin during a median follow-up of 1.8 years, Dr. Christopher B. Granger reported Aug. 28 at the annual congress of the European Society of Cardiology, and in a published article that concurrently appeared online (N. Engl. J. Med. 2011 Aug. 28 [10.1056/NEJMoa1107039]).

Treatment with apixaban as compared with warfarin in patients with AF and at least one additional risk factor for stroke reduces stroke and systemic embolism by [a relative] 21%, reduces major bleeding by [a relative] 31%, and reduces mortality by [a relative] 11%," all statistically significant differences, reported Dr. Granger, director of the cardiac care unit at Duke University in Durham, N.C.