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ARTICLE CONTRIBUTORS

Journal of Stroke & Cerebrovascular Diseases

Clinical Articles, Lead Article

Apixaban beats aspirin for stroke reduction in AF & CKD patients

Apixaban significantly reduces stroke relative to aspirin without a significant increase in major haemorrhage, in patients with atrial fibrillation (AF) and stage III chronic kidney disease (CKD), according to a study1 published recently in the Journal of Stroke & Cerebrovascular Diseases.

Researchers evaluated the efficacy and safety of apixaban 5 mg twice daily (2.5 mg twice daily in selected patients) compared with aspirin 81–324 mg daily in 1,697 patients with stage III CKD enrolled in the Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or are Unsuitable for Vitamin K Antagonist Treatment (AVERROES) trial. Primary outcome was all stroke and non-central nervous system emboli.

Compared with patients with estimated glomerular filtration rates (eGFRs) ≥60 mL/min per 1.73 m2, stage III CKD patients were older with more frequent hypertension, diabetes, heart failure, and previous stroke.

Stage III CKD was an independent predictor of primary events and major haemorrhage. Apixaban* significantly reduced primary events by 68% (5.6% per year on aspirin vs. 1.8% per year on apixaban) for stage III CKD participants and by 43% (2.8% per year on aspirin vs. 1.6% per year on apixaban) for patients with eGFRs ≥60 mL/min per 1.73 m2.

Dr Paul Kalra

Professor Stuart Connolly (McMaster University, Canada)

There was no significant difference in major haemorrhage in stage III CKD patients by treatment: 2.2% per year with aspirin vs. 2.5% per year with apixaban.

Co-author Professor Stuart Connolly (McMaster University, Canada) spoke to BJC Arrhythmia Watch, saying: “Our study is consistent with other recent analyses in demonstrating that stage III CKD (estimated GFR 30–59 ml/min/173m2) is an independent risk factor for stroke in atrial fibrillation patients, and hence the presence of CKD (in an average of 30% of atrial fibrillation patients) is relevant to the decision to use anticoagulants. Apixaban was far superior to aspirin for preventing stroke in atrial fibrillation patients with stage III CKD with similar bleeding risks”.

*Apixaban is not currently licensed for stroke prevention in non-valvular AF

References

1. Eikelboom JW, Connolly SJ, Gao P, et al. Stroke risk and efficacy of apixaban in atrial fibrillation patients with moderate chronic kidney disease. Journal of Stroke & Cerebrovascular Diseases 2012;21:429–35. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.05.007

Published on: August 24, 2012

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  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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