Development of apixaban: a novel anticoagulant for prevention of stroke in patients with atrial fibrillation.
Bottom Line: The factor Xa inhibitor apixaban is one of the novel anticoagulants to emerge as alternatives to long-standing standards of care that include low-molecular-weight heparin and warfarin.Twice-daily dosing of apixaban, rather than once daily, was chosen to lower peak concentrations and reduce fluctuations between peak and trough levels.In the AVERROES study of patients who were unsuitable for warfarin therapy, apixaban was superior to aspirin in reducing the risk of stroke or systemic embolism (SSE), without a significant increase in major bleeding (MB).
Affiliation: Global Clinical Research, Research & Development, Bristol-Myers Squibb Company, Princeton, New Jersey.Show MeSH
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Mentions: Another way to analyze this relationship is as a continuous curve rather than in quartiles. The HR and 95% CI can be plotted for key outcomes across a range of INR control by analyzing the results of subjects from sites where TTR exceeds the specified cutoff. The curves for both SSE and ISTH MB appear in Figure3.37 In both cases, the estimate for the HR and 95% CI were favorable for apixaban, with stability across a wide range of TTRs up to about 80% TTR. Above that value, the very few numbers of events and small numbers of patients in this group (only 9.3% of treated patients achieved a TTR of ≥80%) cause the analysis to break down. These findings provide further evidence that even across a wide range of very good INR control, apixaban is superior to warfarin.
Affiliation: Global Clinical Research, Research & Development, Bristol-Myers Squibb Company, Princeton, New Jersey.