Warfarin vs. Apixaban in Atrial Fibrillation Patients Who Receive Multiple Drugs

Polypharmacy can affect the safety and efficacy of warfarin, given the many known interactions between warfarin and other drugs. However, the effect of polypharmacy on outcomes with direct oral anticoagulants is unclear. In the ARISTOTLE randomized trial, in which 18,000 people with atrial fibrillation (AF) received apixaban (Eliquis) or warfarin, apixaban was superior to warfarin in preventing stroke or systemic embolism and major bleeding and was associated with less major bleeding and lower 2-year all-cause mortality (NEJM JW Gen Med Oct 15 2011 and N Engl J Med 2011; 365:981). In this post hoc analysis of ARISTOTLE data, researchers determined whether the treatment effects of warfarin versus apixaban differed with increasing numbers of …