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Efficacy and Safety...
Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation and Peripheral Artery Disease : Insights From the ARISTOTLE Trial
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- Hu, Peter T. (author)
- Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.
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- Lopes, Renato D. (author)
- Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Stevens, Susanna R. (author)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Wallentin, Lars (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)
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- Thomas, Laine (author)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Alexander, John H. (author)
- Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Hanna, Michael (author)
- Bristol Myers Squibb Co, Princeton, NJ USA.
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- Lewis, Basil S. (author)
- Technion, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Haifa, Israel.
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- Verheugt, Freek W. A. (author)
- Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.
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- Granger, Christopher B. (author)
- Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Jones, W. Schuyler (author)
- Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (creator_code:org_t)
- WILEY-BLACKWELL, 2017
- 2017
- English.
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In: Journal of the American Heart Association. - : WILEY-BLACKWELL. - 2047-9980. ; 6:1
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background- We studied (1) the rates of stroke or systemic embolism and bleeding in patients with atrial fibrillation and peripheral artery disease (PAD) and (2) the efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation with and without PAD. Methods and Results- The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial randomized 18 201 patients with atrial fibrillation to apixaban or warfarin for stroke/systemic embolism prevention; 884 (4.9%) patients had PAD at baseline. Patients with PAD had higher unadjusted rates of stroke and systemic embolism (hazard ratio [HR] 1.73, 95% CI 1.22-2.45; P=0.002) and major bleeding (HR 1.34, 95% CI 1.00-1.81; P=0.05), but after adjustment, no differences existed in rates of stroke and systemic embolism (HR 1.32, 95% CI 0.93-1.88; P=0.12) and major bleeding (HR 1.03, 95% CI 0.76-1.40; P=0.83) compared with patients without PAD. The risk of stroke or systemic embolism was similar in patients assigned to apixaban and warfarin with PAD (HR 0.63, 95% CI 0.32-1.25) and without PAD (HR 0.80, 95% CI 0.66-0.96; interaction P= 0.52). Patients with PAD did not have a statistically significant reduction in major or clinically relevant nonmajor bleeding with apixaban compared with warfarin (HR 1.05, 95% CI 0.69-1.58), whereas those without PAD had a statistically significant reduction (HR 0.65, 95% CI 0.58-0.73; interaction P=0.03). Conclusions- Patients with PAD in ARISTOTLE had a higher crude risk of stroke or systemic embolism compared with patients without PAD that was not present after adjustment. The benefits of apixaban versus warfarin for stroke and systemic embolism were similar in patients with and without PAD. These findings highlight the need to optimize the treatment of patients with atrial fibrillation and PAD.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- apixaban
- atrial fibrillation
- bleeding
- peripheral artery disease
- stroke
- systemic embolism
Publication and Content Type
- ref (subject category)
- art (subject category)
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Hu, Peter T.
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Lopes, Renato D.
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Stevens, Susanna ...
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Wallentin, Lars
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Thomas, Laine
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Alexander, John ...
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Hanna, Michael
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Lewis, Basil S.
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Verheugt, Freek ...
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Granger, Christo ...
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Jones, W. Schuyl ...
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- MEDICAL AND HEALTH SCIENCES
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Uppsala University