TRIP

Apixaban Works in Afib Even With Prior Stroke (CME/CE)

MedPageToday, 2012

and enrolled patients with atrial fibrillation and at least one additional risk factor for stroke.
AVERROES compared apixaban with aspirin in patients who were unsuitable for or unwilling to take vitamin K antagonists and ARISTOTLE compared the new anticoagulant with warfarin.
In AVERROES, apixaban significantly reduced stroke and systemic embolism by a relative 55% without increasing major bleeding, including intracranial hemorrhage.
In ARISTOTLE, apixaban cut the rate of stroke and systemic embolism by a relative 21%, while also reducing major bleeding by 31% and all-cause death by 11%.
A prespecified aim of both trials was to examine apixaban's effectiveness in the subgroup of patients with a prior history of stroke or TIA, for whom aggressive antithrombotic therapy raises concerns about increased bleeding risks.
As would be expected, a substantially greater percentage of these patients had a CHADS 2 score of 3 or higher compared with patients who did not have a prior history of ischemic events (92.2% versus 15.8%).
For all of the outcomes examined, including stroke or systemic embolism and major bleeding, the P -values for the interaction with a history of stroke or TIA were not significant, indicating that apixaban yielded comparable results in each group.
For patients with a prior history of stroke or TIA, apixaban reduced stroke or systemic embolism by a relative 24%, major bleeding by 27%, intracranial hemorrhage by 63%, and all-cause death by 11%.
The results of the AVERROES sub-analysis were largely similar, with no differences in outcomes on the basis of prior history of stroke or TIA; 13.6% of the patients in the trial had such a history.
In the patients with prior stroke or TIA, apixaban reduced stroke or systemic embolism by 71%, with no increases seen in major bleeding or intracranial hemorrhage.
The AVERROES investigators noted that the relatively small number of patients with a prior history of stroke or TIA limited their analysis.