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Clinical Articles, News & Views

Bleeding similarities between aspirin and apixaban

Anatomic sites and predictors of bleeding are similar for apixaban and aspirin in patients with atrial fibrillation (AF) who are unsuitable for vitamin K antagonist therapy, according to a study1 published recently in Stroke.

Higher CHADS2 scores are associated with increasing rates of bleeding and stroke, but the balance between risks and benefits of apixaban compared with aspirin is favourable irrespective of baseline stroke risk, the authors found.

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 randomised 5,599 patients with AF and risk factors to receive either apixaban or aspirin. Bleeding events were defined as the first occurrence of either major bleeding or clinically relevant non-major bleeding.

The rate of a bleeding event was 3.8%/year with aspirin and 4.5%/year with Apixaban. The anatomic site of bleeding did not differ between therapies. Risk factors for bleeding common to apixaban and aspirin were use of non-study aspirin >50% of the time and a history of daily/occasional nosebleeds. The rates of both stroke and bleeding increased with higher CHADS2 scores but apixaban compared with aspirin was associated with a similar relative risk of bleeding and a reduced relative risk of stroke irrespective of CHADS2 category.


1. Flaker GC, Eikelboom JW, Shestakovska O, et al. Bleeding during treatment with aspirin versus apixaban in patients with atrial fibrillation unsuitable for warfarin. Stroke 2012;43:3291–7.​STROKEAHA.112.664144

Published on: December 20, 2012

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    None Found


  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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