AHA: Apixaban Beneficial for Patients With Subclinical A-Fib
By Elana Gotkine HealthDay Reporter
TUESDAY, Nov. 14, 2023 -- Apixaban results in a lower risk for stroke or systemic embolism than aspirin for patients with subclinical atrial fibrillation, according to a study published online Nov. 12 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2023, held from Nov. 11 to 13 in Philadelphia.
Jeff S. Healey, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a trial involving patients with subclinical atrial fibrillation lasting six minutes to 24 hours to examine the potential benefit of treatment with oral anticoagulation. Patients were randomly assigned to apixaban 5 mg twice daily or aspirin 81 mg daily. A total of 4,012 patients were included; 36.1 percent were women.
The researchers found that stroke or systemic embolism occurred in 55 of 2,015 and 86 of 1,997 patients in the apixaban and aspirin groups, respectively (0.78 and 1.24 percent per patient-year, respectively) after a mean follow-up of 3.5 ± 1.8 years (hazard ratio, 0.63). The rate of major bleeding was 1.71 and 0.94 percent per patient-year in the apixaban and aspirin groups, respectively, in the on-treatment population (hazard ratio, 1.80). Fatal bleeding occurred in five and eight patients in the apixaban and aspirin groups, respectively.
"Apixaban treatment in patients with subclinical atrial fibrillation prevented severe strokes at the price of an increased risk of nonfatal bleeding," Emma Svennberg, M.D., Ph.D., from Karolinska University Hospital in Stockholm, writes in an accompanying editorial.
The study was partially funded by the Bristol Myers Squibb-Pfizer Alliance, which manufactures apixaban, and Medtronic.
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Posted November 2023
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