Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial
| Autor: | John J.V. McMurray, Freek W.A. Verheugt, Steen Elkjær Husted, Philippe Gabriel Steg, Marco Alings, Laine Thomas, Michael G. Hanna, Prem Pais, John H. Alexander, Lars Wallentin, Dan Atar, Christopher B. Granger, Basil S. Lewis, Shinya Goto, Philip E. Aylward, Daniel Wojdyla, Kurt Huber, Renato D. Lopes, H. Pouleur |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
concomitant medications
Male medicine.medical_specialty Pyridones Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Embolism Administration Oral Hemorrhage Double-Blind Method Fibrinolytic Agents Internal medicine Atrial Fibrillation medicine Humans Myocardial infarction cardiovascular diseases Stroke Aged Aspirin systemic embolism business.industry Hazard ratio Warfarin Anticoagulants Atrial fibrillation Middle Aged medicine.disease Treatment Outcome major bleeding Anesthesia Concomitant Cardiology Pyrazoles Apixaban Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | European Heart Journal, 35, 4, pp. 224-32 European Heart Journal, 35, 224-32 |
| ISSN: | 0195-668X |
| Popis: | Item does not contain fulltext AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was left to the discretion of the treating physician. In this predefined analysis, simple and marginal structured models were used to adjust for baseline and time-dependent confounders associated with aspirin use. Outcome measures included stroke or systemic embolism, ischaemic stroke, myocardial infarction, mortality, major bleeding, haemorrhagic stroke, major or clinically relevant non-major bleeding, and any bleeding. On Day 1, 4434 (24%) patients were taking aspirin. Irrespective of concomitant aspirin use, apixaban reduced stroke or systemic embolism [with aspirin: apixaban 1.12% vs. warfarin 1.91%, hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.39-0.85 vs. without aspirin: apixaban 1.11% vs. warfarin 1.32%, HR 0.84, 95% CI 0.66-1.07; P interaction = 0.10] and caused less major bleeding than warfarin (with aspirin: apixaban 3.10% vs. warfarin 3.92%, HR 0.77, 95% CI 0.60-0.99 vs. without aspirin: apixaban 1.82% vs. warfarin 2.78%, HR without aspirin 0.65, 95% CI 0.55-0.78; P interaction = 0.29). Similar results were seen in the subgroups of patients with and without arterial vascular disease. CONCLUSION: Apixaban had similar beneficial effects on stroke or systemic embolism and major bleeding compared with warfarin, irrespective of concomitant aspirin use. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|