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Home All Specialties Cardiology

Oral apixaban noninferior to conventional treatment of acute venous thromboembolism

bys25qthea
July 4, 2013
in Cardiology, Chronic Disease
Reading Time: 3 mins read
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Image: PD 

1. Patients with venous thromboembolism (VTE) treated with the oral factor Xa inhibitor apixaban experienced similar outcomes to patients treated with enoxaparin and warfarin. 

2. Patients treated with apixaban experienced significantly fewer adverse bleeding events. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: This safety and efficacy study showed that in uncomplicated patients with VTE, apixaban appears to be a viable option for anticoagulation.  Its oral availability and ease of dosing make it an attractive alternative to warfarin, as does its apparent lower risk of bleeding complication.  However, the INR of the control group was within the therapeutic range only 61% of time, suggesting that tighter control of warfarin therapy may well produce just as impressive results.  Additionally, apixaban is not reversible and requires a minimum of 24 hours to leave the system; therefore it would not be a viable option for patients who require anticoagulation but have risk factors for bleeds.  Lastly, this study was funded by Pfizer and Bristol-Meyers Squibb and did not provide a cost-benefit analysis.

Click to read the study, published today in NEJM

Click to read an editorial, published today in NEJM

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Relevant Reading: The AMPLIFY study

In-Depth [randomized controlled trial]: This study compared the efficacy and safety of abixaban with enoxaparin and warfarin for the treatment of venous thromboembolism. The authors enrolled 5395 patients with VTE (either DVT or PE) from 358 centers across multiple countries.  2691 patients were randomized to receive apixaban while 2704 were assigned to receive conventional therapy (enoxaparin and warfarin).  The primary efficacy outcome was a composite of recurrent VTE or death from VTE.  The primary safety outcome was a composite of major bleeding and clinically relevant nonmajor bleeding.  2.3% of patients receiving apixaban incurred the primary outcome, compared to 2.7% of patients receiving conventional therapy (relative risk 0.84, 95% CI 0.60 0 1.18).  Additionally, 4.3% of patients in the apixaban group experienced clinical bleeds compared to 9.7% receiving conventional therapy.

By Akira Shishido, M.D. and Mitalee Patil

More from this author: Peginesatide is noninferior to epoetin for anemia in hemodialysis patients [EMERALD Trials], Antibiotics improve outcomes in severe acute malnutrition, Carbapenem resistance in Enterobacteriaceae nearly quadrupled in the last decade, Eculizumab treats atypical hemolytic-uremic syndrome, Prone positioning decreases mortality in severe ARDS (PROSEVA Trial), On-demand inhalation treatment for bronchiolitis is superior to fixed schedule treatment, A survey of inflight medical emergencies, Lifestyle intervention in obese diabetics does not affect cardiovascular events

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain. 

Tags: apixabanstrokethromboembolismwarfarin
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