Repositorio
Institucional

Garcia, David A.

Wallentin, Lars

Lopes, Renato D.

Thomas, Laine

Alexander, John H.

Hylek, Elaine M.

Ansell, Jack

Hanna, Michael

Lanas, Fernando

Flaker, Greg

Commerford, Patrick

Xavier, Denis

Vinereanu, Dragos

Yang, Hongqiu

Granger, Christopher B.

Apixaban versus warfarin in patients with atrial fibrillation according to prior warfarin use: Results from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial

MOSBY-ELSEVIER

AMERICAN HEART JOURNAL

en

Background Patients with atrial fibrillation who are vitamin K antagonist (VKA)-naive may have a higher risk of thrombosis and/or bleeding than VKA-experienced patients. Methods and results Using data from ARISTOTLE, we assessed baseline characteristics and the treatment effect of apixaban versus warfarin in the VKA-naive and VKA-experienced cohorts. We compared rates of study drug discontinuation and time-in-therapeutic range. Overall, 7,800 (43%) were VKA naive, and 10,401 were VKA experienced. At baseline, both groups were similar with respect to age and congestive heart failure, hypertension, age, diabetes, stroke score (CHADS(2)). Fewer VKA-naive patients had a history of prior stroke (18% vs 21%) or prior bleeding (10% vs 22%) and were more often female (39% vs 33%). The effect of apixaban on the primary efficacy and safety outcomes was similar in VKA-naive (stroke/systemic embolism: hazard ratio [ HR] 0.86, 95% CI 0.67-1.11 and major bleeding: HR 0.73, 95% CI 0.59-0.91) and VKA-experienced populations (stroke/systemic embolism: HR 0.73, 95% CI 0.57-0.95, P value for interaction = 0.39 and major bleeding: HR 0.66, 95% CI 0.55-0.80, P value for interaction = 0.50). Permanent study drug discontinuation was numerically less likely in patients receiving apixaban whether they were VKA naive (HR for discontinuation: 0.87, 95% CI 0.79-0.95) or VKA experienced (HR for discontinuation: 0.93, 95% CI 0.85-1.02). Among patients receiving warfarin, the mean/median times in therapeutic range were lower in the VKA-naive group (VKA-naive: 57.5/61.4, VKA-experienced: 66.0/69.1, P < .001). Conclusion The treatment effects of apixaban (vs warfarin) were not modified by VKA naivety. The rates of stroke/systemic embolism and major bleeding were numerically lower among the patients assigned to apixaban, irrespective of prior VKA use.

Artículo original

The ARISTOTLE study was funded by Bristol-Myers Squibb and Pfizer.

El estudio ARISTOTLE fue financiado por Bristol-Myers Squibb y Pfizer.

10.1016/j.ahj.2013.05.016

pdf

PREVENTION

THERAPY

COHORTS

RISK

PREVENCIÓN

TERAPIA

COHORTES

RIESGO

PREVENTION

THERAPY

COHORTS

RISK

PREVENCIÓN

TERAPIA

COHORTES

RIESGO

Farmacología y Farmacia

Sistema Cardiovascular y Cardiaco

Medicina General e Interna

Apixaban versus warfarin in patients with atrial fibrillation according to prior warfarin use: Results from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial

AMERICAN HEART JOURNAL

hibrida

verde

metadata

metadata

PMID 24016506

en

Artículo original

versión publicada

Bristol-Myers Squibb#Pfizer

Bristol-Myers Squibb

Pfizer

MOSBY-ELSEVIER

0002-8703

549

558

Sistemas cardíacos y cardiovasculares

Cardiac & Cardiovascular Systems

pdf

WOS:000324163600031