Factor Xa inhibitor Prevents Strokes in Atrial Fibrillation Patients

The primary outcome was ischemic or hemorrhagic stroke, or systemic embolism, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause. The median duration of follow-up was 1.8 years.

The results showed that the rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group. The rate of major bleeding was 2.13% per year in the apixaban group, compared to 3.09% per year in the warfarin group; the rates of death from any cause were 3.52% and 3.94%, respectively, and the rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group. Finally, the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group, and 1.05% per year in the warfarin group. The study was published early online on August 27, 2011, in the New England Journal of Medicine.

“The primary outcome of stroke or systemic embolism occurred in 212 patients in the apixaban group as compared with 265 patients in the warfarin group,” concluded lead author Christopher Granger, MD, of the DUMC, and colleagues. “The lower risk of hemorrhagic stroke suggests there is a specific risk associated with warfarin, possibly related to its inhibition of multiple coagulation factors or interaction between warfarin and tissue factor VIIa complexes in the brain.”

Related Links:
Duke University Medical Center