Analysis: Apixaban Associated with Lower Risks Than Warfarin

Apixaban is associated with a lower risk of bleeding, death, and hospitalization compared with treatment with warfarin, regardless of previous stroke or blood clot history, according to late-breaking data presented at the American Stroke Association’s International Stroke Conference 2020.

The findings, from a secondary analysis of the AUGUSTUS trial, confirm the safety of the blood thinning agent apixaban. The AUGUSTUS trial was first published in March 2019.

The study included 4614 patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) or those undergoing percutaneous coronary intervention (PCI) with planned treatment with a P2Y12 inhibitor. Patients received either apixaban or a vitamin K antagonist, and aspirin or matching placebo for 6 months.

Of the 4581 patients with information available about prior stroke, 13.8% had prior stroke/transient ischemic attack or thromboembolism, according to the analysis.

Overall, treatment with apixaban without aspirin was associated with less bleeding and fewer deaths and hospitalizations compared with a vitamin K antagonist plus aspirin in the study participants.

The data showed that patients with prior stroke history were at increased risk of ischemic stroke, bleeding, hospitalization or death compared with those with no prior stroke. Apixaban without aspirin was associated with the lowest rate of these risks, regardless of prior history, and the highest rate of bleeding was seen in patients who received both the vitamin K antagonist and aspirin.

Additionally, patients with no prior events who received aspirin had a higher risk of bleeding compared with placebo. There was no significant difference between aspirin and placebo observed between patients with and without prior stroke for other clinical outcomes.

“These results reinforce the main results of the AUGUSTUS trial by assuring physicians that even in a high-risk group of patients with prior stroke ‘less is more’,” lead study author Maria Cecilia Bahit, MD, chief of cardiology at INECO Neurociencias, said in a statement. “Apixaban was safer than warfarin–causing less major bleeding–and more effective, resulting in less death or hospitalization in both groups.”

References:

1. Secondary analysis confirms safety of blood thinning agent [news release]. American Heart Association’s website. https://newsroom.heart.org/news/secondary-analysis-confirms-safety-of-blood-thinning-agent?preview=78d9. Accessed February 24, 2020.