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Circulation: arrhythmia and electrophysiology

Clinical Articles, News & Views

Outcomes with aspirin versus apixaban in patients with AF

In an atrial fibrillation (AF) population, apixaban was superior to aspirin for stroke prevention. There were similar rates of major bleeding, in the presence of one or more stroke risk factors, with consistency of the treatment effect by CHADS2/CHA2DS2-VASc scores, according to a study1 published recently in Circulation: arrhythmia and electrophysiology.

In this secondary analysis of the AVERROES (Apixaban versus Acetylsalicylic Acid to Prevent Strokes) trial, the principal objective was to assess the effect of treatment with aspirin or apixaban on ischaemic stroke and major bleeding, in relation to the CHADS2/CHA2DS2-VASc scores. Investigators found no significant heterogeneity for treatment efficacy on ischaemic stroke for apixaban when subdivided by stroke risk strata, based on CHADS2/CHA2DS2-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 CHADS2/CHA2DS2-VASc scores, according to the authors.

In multivariable analysis, significant predictors of stroke on aspirin were age ≥75 years, prior stroke or transient ischaemic attack, estimated glomerular filtration rate <60 mL/min, and non-paroxysmal AF. Proportions of the study cohort classified as low/moderate/high risk using the CHADS2 and CHA2DS2-VASc scores were 0.3%/71.7%/28.1% and <0.1%/10.5%/89.5%, respectively.

References

1. Lip GYH, Connolly S, Yusuf S, et al. on behalf of the AVERROES Investigators. 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. Circulation: arrhythmia and electrophysiology 2013;6:31–8. http://dx.doi.org/10.1161/​CIRCEP.112.975847

Published on: February 28, 2013

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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