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Review
. 2017 Mar;11(3):91-104.
doi: 10.1177/1753944716652787. Epub 2016 Jul 31.

Apixaban to prevent stroke in patients with atrial fibrillation: a review

Benjamin E Peterson  1 , Sana M Al-Khatib  2 , Christopher B Granger  2
Affiliations
Review

Apixaban to prevent stroke in patients with atrial fibrillation: a review

Benjamin E Peterson et al. Ther Adv Cardiovasc Dis. 2017 Mar.

Abstract

Atrial fibrillation is a common, costly and morbid cardiovascular arrhythmia. Stroke prevention remains the mainstay of treatment for atrial fibrillation, and the recent advent of novel oral anticoagulants with direct factor IIa or factor Xa inhibition has significantly revolutionized this aspect of treatment for atrial fibrillation patients. This review focuses on the tolerability and efficacy of apixaban and tackles the generalizability of the findings with apixaban to broader patient populations than those primarily enrolled in the clinical trials, drawing from the AVERROES and ARISTOTLE trials and their subsequent secondary analyses. Taken together, findings from these trials show that apixaban is superior to warfarin in preventing stroke with a lower risk of major bleeding in the general population of patients with atrial fibrillation as well as in several key high-risk patient subgroups.

Keywords: anticoagulation; atrial fibrillation; stroke.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Comparison of the effects of apixaban versus control on major clinical outcomes in the ARISTOTLE and AVERROES trials [Connolly et al. 2011; Granger et al. 2011].
Figure 2.
Figure 2.
30-day mortality related to major bleeding events in patients taking apixaban versus warfarin [Hylek et al. 2014]. HR, hazard ratio; CI, confidence interval.
Figure 3.
Figure 3.
(A) Stroke and systemic embolism (% per year) by baseline glomerular filtration rate (GFR). (B) Major bleeding events (% per year) by baseline GFR [Hohnloser et al. 2012]. eGFR, estimated glomerular filtration rate.
Figure 4.
Figure 4.
Study outcomes from the ARISTOTLE trial by age [Halvorsen et al. 2014]. HR, hazard ratio; CI, confidence interval; Pts, patients; Yrs, years.
Figure 5.
Figure 5.
Stroke and systemic embolism in patients with and without previous stroke and treated with warfarin versus apixaban. With prior CVA: 2.46% per year on apixaban versus 3.24% per year on warfarin [hazard ratio (HR) for apixaban 0.76]; without prior CVA: 1.01% per year on apixaban versus 1.32 per year on warfarin (HR for apixaban 0.82); p for interaction = 0.71 [Easton et al. 2012]. TIA, transient ischemic attack.
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References

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