Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .
Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation and Peripheral Artery Disease: Insights From the ARISTOTLE Trial
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 r and omized 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 clinical ly 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 . Clinical Trial Registration URL : http://www . clinical trials.gov . Unique identifier : NCT00412984
Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .