Anticoagulant Decreases Risk of Stroke, Bleeding in Some AF Patients

Apixaban decreases the risks of stroke and bleeding among anticoagulation-naïve patients with atrial fibrillation (AF) receiving elective cardioversion, according to a recent study.

Findings were presented by Dr Michael Ezekowitz on August 28, 2017, at the European Society of Cardiology Congress in Barcelona, Spain.
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To assess the effects of apixaban vs usual care (warfarin) on the risks of bleeding and stroke, the researchers assessed 1500 anticoagulation-naïve patients receiving elective cardioversion of primarily new-onset non-valvular AF in the EMANATE trial. The researchers defined anticoagulation-naïve as having received less than 48 hours of anticoagulation therapy.

During the trial, patients received either 5 mg oral apixaban (n = 753) twice daily or warfarin with heparin (n = 747). Patients receiving apixaban who were age 80 years or older, weighed approximately 132 lbs or less, and/or had serum creatinine levels of 1.5 mg/dL or more received 2.5 mg apixaban twice daily. Additionally, if the cardioversion was immediate, patients could receive an initial 10 mg or 5 mg loading dose of apixaban, at the discretion of the attending provider.

Incidence of stroke, systemic embolism, death, major bleeding, and clinically relevant non-major bleeding were compared between groups.

Results indicated that patients who received apixaban had fewer strokes and similar incidence of bleeding compared with those receiving usual care. There were no strokes among patients who had received apixaban. However, 6 strokes were reported among patients who had received usual care. Furthermore, 3 major bleeds were reported among patients receiving apixaban and 6 patients receiving usual care. Clinically significant non-major bleeds were reported in 11 patients receiving apixaban and 13 patients receiving usual care.

Additionally, 342 patients who received apixaban had received a loading dose. Among these patients, no strokes or systemic embolic events were reported. However, there was 1 death, 1 major bleed, and 4 clinically relevant non-major bleeds.

“In patients with atrial fibrillation undergoing cardioversion, apixaban with or without a loading dose was safe, resulting in few bleeding events and less strokes than conventional anticoagulant therapy,” the researchers concluded. “We expect these findings will be translated into clinical practice.”

—Christina Vogt

Reference:

Apixaban lowers stroke risk in atrial fibrillation patients undergoing cardioversion (EMANATE) [press release]. Barcelona, Spain: European Society of Cardiology; August 28, 2017. https://www.escardio.org/The-ESC/Press-Office/Press-releases/PCSK9-inhibition-could-ameliorate-cardiovascular-disease-by-immune-mechanisms. Accessed August 28, 2017.