In a nutshell
This study compared the effect and safety of apixaban (Eliquis) and warfarin for the prevention of stroke among patients of different ages with atrial fibrillation.
Some background
Atrial fibrillation is an irregular heart beat condition that may cause blood to pool and clot. If a blood clot forms it can be pumped to the brain, blocking off the blood supply and resulting in a stroke.
Treatment for atrial fibrillation includes the use of anticoagulants that prevent blood clot formation. Apixaban and warfarin are effective anticoagulants but can cause excessive bleeding if the dose is not tightly regulated.
The risk of stroke in patients with atrial fibrillation increases with age. This study compared the use of apixaban and warfarin in preventing stroke in patients with atrial fibrillation in relation to patient age.
Methods & findings
A total of 18,201 patients with atrial fibrillation were randomly assigned either 5 mg twice daily of apixaban or warfarin. Patients who were considered high risk for stroke i.e. either older than 80 years, weighing over 60 kg or had poor kidney function received 2.5 mg twice daily.
After approximately 2 years, apixaban was found to be more effective than warfarin in preventing stroke and reducing mortality across all age groups, and was associated with less bleeding and less intracranial hemorrhage (ruptured blood vessel in the brain). The results were also consistent for the 13% of patients >70 years.
The bottom line
Apixaban was shown to be more effective at reducing stroke, mortality, and adverse bleeding than warfarin across all ages.
The fine print
A bias towards more healthy patients being included in the study is likely, however, 49% of patients aged >75 years were actually high-risk for stroke.
What’s next?
If you or someone you know have atrial fibrillation, discuss with your doctor the benefits and risks of receiving apixaban over warfarin.
Published By :
European Heart Journal
Date :
Feb 20, 2014
