He received drug-eluting stents about 1. He reports no symptoms of gastrointestinal bleeding and does not smoke. How should you manage antithrombotic therapy in this patient? In patients with atrial fibrillation, the current guidelines recommend anticoagulation with vitamin K antagonists or direct oral anticoagulants to reduce thromboembolic events because it has been shown to be superior to antiplatelet therapy.

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Brady L. Blood Adv Aug 13 In a real-world comparison, the benefit-to-risk ratio favored apixaban with similar efficacy and lower rates of bleeding. Direct oral anticoagulants DOACs are now more commonly prescribed than vitamin K antagonists owing to better predictability and reliability, a lack of need for monitoring, and reduced risk for bleeding.

Among DOACs, apixaban and rivaroxaban are more commonly used for patients with acute venous thromboembolism VTE than dabigatran or edoxaban, which require heparin or low-molecular-weight heparin bridging. Now, investigators have performed a meta-analysis of five studies 4 retrospective, 1 prospective to compare the efficacy and safety of apixaban versus rivaroxaban in a total of 24, patients with acute VTE not atrial fibrillation in real-world settings.

The primary outcomes were VTE recurrence at 6 months and major and minor bleeding. Key findings were as follows: Rates of recurrent VTE were comparable between apixaban and rivaroxaban 1. The rate of clinically relevant major bleeding was lower with apixaban than with rivaroxaban 0.

Comment Investigators speculate that lower bleeding rates with apixaban could be explained by its pharmacokinetics, including a lower peak-to-trough ratio when used twice daily. The authors acknowledge limitations of the meta-analysis, including confounding inherent in the retrospective studies as well as a lack of key details, such as the possibility of underdosing in the apixaban arm.

Nevertheless, this real-world study is intriguing, especially if the results are confirmed by a direct comparison between apixaban and rivaroxaban in a randomized study that is currently underway NCT


AUGUSTUS: Less Bleeding, Fewer Events With Apixaban and No Aspirin in Patients With AFib and ACS

A A Patients with both atrial fibrillation AFib and acute coronary syndrome ACS had a significantly reduced risk of bleeding when treated with apixaban vs. The results were also published simultaneously in the New England Journal of Medicine. A total of 4, patients median age, All patients were required to be taking clopidogrel 90 percent did or another P2Y12 inhibitor during the trial.



Print 1. Apixaban was found to be non-inferior to conventional therapy i. Major bleeding was found to be significantly less common in patients treated with apixaban as compared with conventional therapy. Original Date of Publication: August Study Rundown: New oral anticoagulants are being increasingly used for a number of different indications, including stroke prophylaxis in patients with atrial fibrillation and treatment of venous thromboembolic disease. The rate of major bleeding was found to be significantly lower in patients treated with apixaban as compared with conventional therapy. Click to read study in NEJM In-Depth [randomized controlled trial]: This randomized, non-inferiority trial was conducted at centres in 28 countries. A total of 5, patients were enrolled and randomized to treatment with apixaban or conventional therapy i.


NEJM Journal Watch

Chest Dec Abraham NS et al. Gastroenterology Dec 31 In an observational study, apixaban was associated with the least major bleeding. In this observational study, Mayo Clinic researchers used an insurance database to compare effectiveness and safety of the three most-commonly prescribed DOACs dabigatran [Pradaxa], apixaban [Eliquis], and rivaroxaban [Xarelto] in patients with nonvalvular atrial fibrillation. Using propensity-score matching, demographically and clinically similar cohorts were created for each two-way comparison: The rivaroxaban—dabigatran comparison had 15, patients in each group, and the apixaban—dabigatran and apixaban—rivaroxaban comparisons had about patients in each group.


Antithrombotic Regime for Patients with Stable Coronary Artery Disease and Atrial Fibrillation

Whether direct oral anticoagulants DOACs would be safe and effective for this indication is unclear. Apixaban versus warfarin in patients with atrial fibrillation. Vitamin K antagonists are highly effective in preventing stroke in patients with apxaban fibrillation but have several limitations. Comment in N Engl J Med. The post-marketing requirement is a trial in which patients will be randomized to receive either andexanet alfa or usual care.

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