This week’s New England Journal of Medicine reported a study demonstrating that in patients with atrial fibrillation (Afib), apixaban, a new oral anticoagulant, is superior to warfarin in preventing strokes as well as causing less bleeding, and overall resulted in fewer deaths.
The most serious complication of Afib is stroke. The standard treatment to prevent stroke is the oral anticoagulant, warfarin (Coumadin®), which will reduce the risk of stroke by as much as 2/3rds. Warfarin therapy, however, is fraught with difficulties of dose management requiring frequent monitoring. It is associated with a risk of major bleeding in approximately 2% of patients and the frequency may be much higher if the dose is not managed well.
Apixaban (Bristol-Myers Squibb and Pfizer) is one of several new oral anticoagulants developed in the last several years to replace warfarin for the treatment of Afib. Apixaban and the other new drugs do not require monitoring and have many fewer drug interactions compared to warfarin. One of the new drugs, Dabigatran/Pradaxa (Boehringer Ingelheim) was approved by the FDA last year for Afib patients. Apixaban is not yet approved by the FDA.
The Apixaban study included 18,000 patients and it showed that those treated with Apixaban had 21% fewer strokes, 31% fewer major bleeding episodes and 11% fewer deaths as compared to Warfarin.
Chair of NBCA’s Medical and Scientific Advisory Board and coauthor of the study, Jack Ansell, MD, said “ these results are quite impressive and represent a major advance in the prevention of stroke for patients with Afib.” Dr. Ansell added “ I am optimistic that emerging data for apixaban and other new anticoagulants will offer new options for preventing DVT/PE.” David Garcia, MD, another MASAB member is also a coauthor of the study.