Repositorio UFRO · Omeka S

Modification of Outcomes With Aspirin or Apixaban in Relation to CHADS2 and CHA2DS2-VASc Scores in Patients With Atrial Fibrillation A Secondary Analysis of the AVERROES Study

Primer Autor	Lip, Gregory Y. H.
Co-autores	Connolly, Stuart Yusuf, Salim Shestakovska, Olga Flaker, Greg Hart, Robert Lanas, Fernando Xavier, Denis Eikelboom, John
Título	Modification of Outcomes With Aspirin or Apixaban in Relation to CHADS2 and CHA2DS2-VASc Scores in Patients With Atrial Fibrillation A Secondary Analysis of the AVERROES Study
Editorial	LIPPINCOTT WILLIAMS & WILKINS
Revista	CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
Lenguaje	en
Resumen	Background-The impact of apixaban versus aspirin on ischemic stroke and major bleeding in relation to the CHADS(2) and CHA(2)DS(2)-VASc stroke risk scores in atrial fibrillation has not been investigated. Methods and Results-In this secondary analysis of the AVERROES trial, our principal objective was to assess the effect of treatment with aspirin or apixaban on ischemic stroke and major bleeding, in relation to the CHADS(2)/CHA(2)DS(2)-VASc scores. We found no significant heterogeneity for treatment efficacy on ischemic stroke for apixaban when subdivided by stroke risk strata, based on CHADS(2)/CHA(2)DS(2)-VASc. Effects were consistent irrespective of baseline risk, and thus, absolute benefits were greatest in the high-risk groups. There was also no significant heterogeneity for apixaban versus aspirin with regard to major bleeding, when subdivided by CHADS(2)/CHA(2)DS(2)-VASc scores. In multivariable analysis, significant predictors of stroke on aspirin were age >= 75 years, prior stroke or transient ischemic attack, estimated glomerular filtration rate <60 mL/min, and nonparoxysmal atrial fibrillation. Proportions of the study cohort classified as low/moderate/high risk using the CHADS(2) and CHA(2)DS(2)-VASc scores were 0.3%/71.7%/28.1% and <0.1%/10.5%/89.5%, respectively. Conclusions-In an atrial fibrillation population, apixaban was superior to aspirin for stroke prevention, with similar rates of major bleeding, in the presence of one or more stroke risk factors, with consistency of the treatment effect by CHADS(2)/CHA(2)DS(2)-VASc scores.
Tipo de Recurso	Artículo original
Description	Dr Lip receiving consulting fees from Astellas, Boehringer Ingelheim, Bayer, Daiichi, Merck, Portola, Biotronic, Sanofi-Aventis, and AstraZeneca, grant support on behalf of his institution, City Hospital, from Bayer, lecture fees from Boehringer Ingelheim, Bayer, Merck, and Sanofi-Aventis, and payment from Boehringer Ingelheim for developing educational presentations. Dr Eikelboom, receiving consulting fees from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca, and Novartis, and lecture fees from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, and AstraZeneca. Dr Yusuf, receiving consulting fees from Boehringer Ingelheim, Sanofi-Aventis, Novartis, AstraZeneca, Bristol-Myers Squibb, and Glaxo-SmithKline, and grant support from Boehringer Ingelheim, Sanofi-Aventis, Novartis, AstraZeneca, GlaxoSmithKline, and Bristol-Myers Squibb. Dr Hart: Consultant to Sanofi-Aventis for service on the stroke advisory and adjudication committee for a phase III randomized clinical trial testing a novel antiarrhythmic agent in patients with atrial fibrillation (2008-2011). Consultant to Bristol Myers-Squibb for service on the operations, stroke advisory, and stroke adjudication committee for a phase III randomized clinical trial testing the novel oral anticoagulant apixaban in patients with atrial fibrillation (AVERROES trial 2008-2010). Consultant to Biotronik for service on a data monitoring committee for a clinical trial assessing novel detection device for atrial fibrillation. Consultant to Boehringer Ingelheim for analysis of intracranial hemorrhages occurring during a phase III trial testing dabigatran versus warfarin in patients with atrial fibrillation (RE-LY). Coprincipal investigator on an NIH/NINDS-sponsored phase III multicenter clinical trial testing antiplatelet agents, and blood pressure control for secondary prevention of small subcortical lacunar strokes (SPS3) for which I receive salary support (2003-2012). Johnson & Johnson, Mock FDA advisory committee for ROCKET AF ( 2011). Dr Connolly reports receiving payment for serving on the boards of Boehringer Ingelheim, Sanofi-Aventis, Portola, and Merck, consulting fees from Boehringer Ingelheim, Sanofi-Aventis, Portola, and Merck, grant support on behalf of his institution, McMaster University, from Boehringer Ingelheim, Sanofi-Aventis, Portola, and Bristol-Myers Squibb, and lecture fees from Boehringer Ingelheim, Sanofi-Aventis, and Portola. El Dr. Lip recibe honorarios de consultoría de Astellas, Boehringer Ingelheim, Bayer, Daiichi, Merck, Portola, Biotronic, Sanofi-Aventis y AstraZeneca, apoyo financiero para su institución, el City Hospital, de Bayer, honorarios por conferencias de Boehringer Ingelheim, Bayer, Merck y Sanofi-Aventis, y pagos de Boehringer Ingelheim por el desarrollo de presentaciones educativas. El Dr. Eikelboom recibe honorarios de consultoría de Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca y Novartis, y honorarios por conferencias de Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly y AstraZeneca. El Dr. Yusuf recibe honorarios de consultoría de Boehringer Ingelheim, Sanofi-Aventis, Novartis, AstraZeneca, Bristol-Myers Squibb y Glaxo-SmithKline, y apoyo financiero de Boehringer Ingelheim, Sanofi-Aventis, Novartis, AstraZeneca, GlaxoSmithKline y Bristol-Myers Squibb. El Dr. Hart es consultor de Sanofi-Aventis por su participación en el comité asesor y de adjudicación de accidentes cerebrovasculares para un ensayo clínico aleatorizado de fase III que evalúa un nuevo agente antiarrítmico en pacientes con fibrilación auricular (2008-2011). También es consultor de Bristol Myers-Squibb por su participación en el comité de operaciones, asesoramiento de accidentes cerebrovasculares y comité de adjudicación de accidentes cerebrovasculares para un ensayo clínico aleatorizado de fase III que evalúa el nuevo anticoagulante oral apixabán en pacientes con fibrilación auricular (ensayo AVERROES 2008-2010). Consultor de Biotronik para el servicio en un comité de monitoreo de datos para un ensayo clínico que evalúa un nuevo dispositivo de detección de fibrilación auricular. Consultor de Boehringer Ingelheim para el análisis de hemorragias intracraneales ocurridas durante un ensayo de fase III que prueba dabigatrán versus warfarina en pacientes con fibrilación auricular (RE-LY). Coinvestigador principal en un ensayo clínico multicéntrico de fase III patrocinado por NIH/NINDS que prueba agentes antiplaquetarios y control de la presión arterial para la prevención secundaria de pequeños accidentes cerebrovasculares lacunares subcorticales (SPS3) para el cual recibo apoyo salarial (2003-2012). Johnson & Johnson, Comité asesor simulado de la FDA para ROCKET AF (2011). El Dr. Connolly declara haber recibido pagos por formar parte de los consejos de administración de Boehringer Ingelheim, Sanofi-Aventis, Portola y Merck, honorarios por consultoría de Boehringer Ingelheim, Sanofi-Aventis, Portola y Merck, subvenciones en nombre de su institución, la Universidad McMaster, de Boehringer Ingelheim, Sanofi-Aventis, Portola y Bristol-Myers Squibb, y honorarios por conferencias de Boehringer Ingelheim, Sanofi-Aventis y Portola.
doi	10.1161/CIRCEP.112.975847
Formato Recurso	pdf
Palabras Claves	apixaban aspirin atrial fibrillation risk stratification stroke prevention STROKE RISK STRATIFICATION PREDICTING STROKE EUROPEAN-SOCIETY THROMBOEMBOLISM ANTICOAGULATION PREVENTION THROMBOPROPHYLAXIS VALIDATION MANAGEMENT SCHEMES apixabán aspirina fibrilación auricular estratificación del riesgo prevención del ictus ESTRATIFICACIÓN DEL RIESGO DE ACCIDENTE CEREBROVASCULAR PREDICCIÓN DE ACCIDENTE CEREBROVASCULAR SOCIEDAD EUROPEA TROMBOEMBOLISMO ANTICOAGULACIÓN PREVENCIÓN TROMBOPROFILAXIS VALIDACIÓN MANEJO ESQUEMAS
Ubicación del archivo	http://dx.doi.org/10.1161/CIRCEP.112.975847
Materias	apixaban aspirin atrial fibrillation risk stratification stroke prevention STROKE RISK STRATIFICATION PREDICTING STROKE EUROPEAN-SOCIETY THROMBOEMBOLISM ANTICOAGULATION PREVENTION THROMBOPROPHYLAXIS VALIDATION MANAGEMENT SCHEMES apixabán aspirina fibrilación auricular estratificación del riesgo prevención del ictus ESTRATIFICACIÓN DEL RIESGO DE ACCIDENTE CEREBROVASCULAR PREDICCIÓN DE ACCIDENTE CEREBROVASCULAR SOCIEDAD EUROPEA TROMBOEMBOLISMO ANTICOAGULACIÓN PREVENCIÓN TROMBOPROFILAXIS VALIDACIÓN MANEJO ESQUEMAS
Disciplinas de la OCDE	Sistema Cardiovascular y Cardiaco Medicina General e Interna Farmacología y Farmacia
Título de la cita (Recomendado-único)	Modification of Outcomes With Aspirin or Apixaban in Relation to CHADS2 and CHA2DS2-VASc Scores in Patients With Atrial Fibrillation A Secondary Analysis of the AVERROES Study
Revista/Libro	CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
Tipo de ruta	hibrida verde
Access Rights	acceso abierto
Derechos de acceso	acceso abierto
Identificador alternativo	PMID 23390125
Idioma	en
Identificador del recurso (Mandatado-único)	Artículo original
Versión del recurso (Recomendado-único)	versión publicada
Entidad financiadora	Astellas#Boehringer Ingelheim#Bayer#Daiichi#Merck#Portola#Biotronic#Sanofi-Aventis#AstraZeneca#Bristol-Myers Squibb#Eli Lilly#Novartis#Glaxo-SmithKline#NIH/NINDS#McMaster University
Referencia del Financiador (Mandatado si es aplicable-repetible)	Astellas Boehringer Ingelheim Bayer Daiichi Merck Portola Biotronic Sanofi-Aventis AstraZeneca Bristol-Myers Squibb Eli Lilly Novartis Glaxo-SmithKline NIH/NINDS McMaster University
Editorial	LIPPINCOTT WILLIAMS & WILKINS
ISSN	1941-3149
Página de inicio (Recomendado-único)	31
Página final (Recomendado-único)	38
Categoría WOS	Sistemas cardíacos y cardiovasculares Cardiac & Cardiovascular Systems
Formato	pdf
Id de Web of Science	WOS:000320670700010