Apixaban vs. Warfarin: Effects Compared in AF Patients With, Without PAD

The benefits of apixaban on stroke/systemic embolism and all-cause death vs. warfarin are similar in patients with and without peripheral artery disease (PAD), but a greater reduction in bleeding was seen in apixaban-treated patients without PAD, a post hoc analysis presented at the American Heart Association Scientific Sessions 2015 shows.

Researchers conducted a post hoc analysis of the ARISTOTLE trial which included patients with atrial fibrillation (AF) and a risk of stroke treated with either apixaban or warfarin for the prevention of stroke/ systemic embolism. Peter Hu, MD, Duke University Medical Center, Durham, NC, and his team set out to determine the absolute rates of stroke/systemic embolism and bleeding associated with PAD, as well as the efficacy and safety of apixaban vs. warfarin in AF patients with and without PAD.

The post hoc analysis showed that patients with PAD had non-significantly higher rates of stroke/systemic embolism [HR 1.32, 95% CI 0.93-1.88, P=0.12] and major or clinically relevant non-major (CRNM) bleeding [HR 1.12, 95% CI 0.90-1.39, P=0.31] vs. patients without PAD. Risk of all-cause death [HR 1.36, 95% CI 1.11-1.67, P=0.003] and CV death [HR 1.44, 95% CI 1.08-1.90, P=0.01] was higher in patients with PAD compared to those without. No difference in the effect of apixaban vs. warfarin for the prevention of stroke/systemic embolism was seen in patients with PAD [HR 0.66, 95% CI 0.33- 1.31] and without PAD [HR 0.80, 95% CI 0.66-0.96, interaction P=0.61]. However, patients with PAD appeared to have less reduction in major or CRNM bleeding with apixaban compared with warfarin [HR 1.04, 95% CI 0.69-1.57] vs. those without PAD [HR 0.66, 95% CI 0.59-0.73, interaction P=0.03].

Apixaban (Eliquis; BMS & Pfizer) is a Factor Xa inhibitor, and warfarin is a vitamin K antagonist.

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