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 .
Clinical outcomes in patients with atrial fibrillation according to sex during anticoagulation with apixaban or warfarin: a secondary analysis of a randomized controlled trial.
AIM To assess clinical outcomes , efficacy , and safety according to sex during anticoagulation with apixaban compared with warfarin in patients with atrial fibrillation . METHODS AND RESULTS Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) was a r and omized , double-blind , placebo-controlled , multicentre trial that included 11 785 ( 64.7 % ) men and 6416 ( 35.3 % ) women with atrial fibrillation or flutter r and omized to receive either warfarin or apixaban .  The primary efficacy endpoint was stroke or systemic embolism ; secondary efficacy endpoints were death from any cause and cardiovascular death . The primary safety endpoint was major bleeding ; secondary safety endpoints were a composite of major bleeding and non-major clinical ly relevant bleeding . The risk of stroke or systemic embolism was similar in women vs. men [ adjusted hazard ratio ( adjHR ) : 0.91 ; 95 % confidence interval ( CI ) : 0.74 - 1.12 ; P = 0.38 ] . However , among patients with history of stroke or transient ischaemic attack , women had a lower risk of recurrent stroke compared with men ( adjHR : 0.70 ; 95 % CI : 0.50 - 0.97 ; P = 0.036 ) . Women also had a lower risk of all-cause death ( adjHR : 0.63 ; 95 % CI : 0.55 - 0.73 ; P < 0.0001 ) and cardiovascular death ( adjHR : 0.62 ; 95 % CI : 0.51 - 0.75 ; P < 0.0001 ) , and a trend towards less major bleeding ( adjHR : 0.86 ; 95 % CI : 0.74 - 1.01 ; P = 0.066 ) and major or non-major clinical ly relevant bleeding ( adjHR : 0.89 ; 95 % CI : 0.80 - 1.00 ; P = 0.049 ) . The efficacy and safety benefits of apixaban compared with warfarin were consistent regardless of sex . CONCLUSION In the ARISTOTLE trial , women had a similar rate of stroke or systemic embolism but a lower risk of mortality and less clinical ly relevant bleeding than men . The efficacy and safety benefits of apixaban compared with warfarin were consistent in men and women . TRIAL REGISTRATION ARISTOTLE Clinical Trials.gov number , 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 .