When compared with warfarin, apixaban has been shown to be more effective at preventing stroke and is safer for patients with atrial fibrillation (AF), but is this benefit preserved in patients who are on multiple medications?  Results from the ARISTOTLE trial presented at the American Heart Association Scientific Sessions 2015 provides new insights.

Patients enrolled in the study (n=18,201) were categorized into tertiles according to the number of concomitant drugs used at baseline (median number of drugs was 6). Researchers then assessed what effect these drugs had on the effectiveness of apixaban and warfarin and how this influenced clinical outcomes.

Older patients, females, and those with comorbidities were more likely to be on multiple medications. The rates of safety and efficacy outcomes increased across tertiles during the median follow-up of 1.8 years. Regardless of the number of concomitant medications, apixaban was superior when compared to warfarin in reducing stroke and systemic embolism (P=0.8203); the safety benefit of apixaban however decreased with the number of drugs taken (P=0.0173). Study authors also observed a similar pattern in net clinical benefit.

Researchers concluded that apixaban is a more effective and a comparably safe alternative to warfarin in patients with AF with polypharmacy.

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

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