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Apixaban compared to heparin/vitamin K antagonist in patients with atrial fibrillation scheduled for cardioversion : the EMANATE trial
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- Ezekowitz, Michael D. (author)
- Thomas Jefferson Univ, Sidney Kimmel Med Coll, Philadelphia, PA 19107 USA;Lankenau Heart Ctr, Wynnewood, PA 19096 USA;Bryn Mawr Hosp, Bryn Mawr, PA USA
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- Pollack, Charles V., Jr. (author)
- Thomas Jefferson Univ, Philadelphia, PA 19107 USA
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- Halperin, Jonathan L. (author)
- Icahn Sch Med, New York, NY USA
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- (creator_code:org_t)
- 2018-04-06
- 2018
- English.
- In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 39:32, s. 2959-2971
- Journal article (peer-reviewed)
Abstract
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- Aim The primary objective was to compare apixaban to heparin/ vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) and <= 48 h anticoagulation prior to randomization undergoing cardioversion. Methods One thousand five hundred patients were randomized. The apixaban dose of 5mg b.i.d. was reduced to 2.5 mg b.i.d. in patients with two of the following: age >= 80 years, weight <= 60 kg, or serum creatinine >= 133 mu mol/L. To expedite cardioversion, at the discretion of the investigator, imaging and/or a loading dose of 10 mg (down-titrated to 5 mg) was allowed. The endpoints for efficacy were stroke, systemic embolism (SE), and death. The endpoints for safety were major bleeding and clinically relevant non-major (CRNM) bleeding. Results There were 1038 active and 300 spontaneous cardioversions; 162 patients were not cardioverted. Imaging was performed in 855 patients, and 342 received a loading dose of apixaban. Comparing apixaban to heparin/VKA in the full analysis set, there were 0/753 vs. 6/747 strokes [relative risk (RR) 0; 95% confidence interval (95% CI) 0-0.64; nominal P = 0.015], no SE, and 2 vs. 1 deaths (RR 1.98; 95% CI 0.19-54.00; nominal P > 0.999). In the safety population, there were 3/735 vs. 6/721 major (RR 0.49; 95% CI 0.10-2.07; nominal P = 0.338) and 11 vs. 13 CRNM bleeding events (RR 0.83; 95% CI 0.34-1.89; nominal P = 0.685). On imaging, 60/61 with thrombi continued randomized treatment; all (61) were without outcome events. Conclusions Rates of strokes, systemic emboli, deaths, and bleeds were low for both apixaban and heparin/VKA treated AF patients undergoing cardioversion.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Apixaban
- Heparin/vitamin K antagonist
- Cardioversion
- Atrial fibrillation
- Stroke
- Anticoagulation
- Cardiac imaging
Publication and Content Type
- ref (subject category)
- art (subject category)
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