Apixaban Outperforms Warfarin in Preventing Stroke in Atrial Fibrillation

The direct factor Xa inhibitor apixaban joins dabigatran and rivaroxaban as potential alternatives to warfarin for preventing stroke in atrial fibrillation, according to an industry-funded study in the New England Journal of Medicine.

ARISTOTLE trial researchers randomized roughly 18,000 patients with atrial fibrillation and at least one additional risk factor for stroke to either daily oral apixaban or warfarin. During a median follow-up of almost 2 years, the primary efficacy outcome — stroke or systemic embolism — occurred less often with apixaban. Similarly, rates of major bleeding and death from any cause favored apixaban.

An editorialist says switching from warfarin might not be necessary in patients in whom anticoagulation is well controlled. In addition to that, she raises the question of cost effectiveness and the lack, so far, of head-to-head comparisons between the newer drugs.