Cited by 2,483Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

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Apixaban in Patients with Atrial Fibrillation

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Connolly, Stuart J., Eikelboom, John, Joyner, Campbell, Diener, Hans-Christoph, Hart, Robert, Golitsyn, Sergey, Flaker, Greg, Avezum, Alvaro, Hohnloser, Stefan H., Diaz, Rafael, Talajic, Mario, Zhu, Jun, Pais, Prem, Budaj, Andrzej, Parkhomenko, Alexander, Jansky, Petr, Commerford, Patrick, Tan, Ru San, Sim, Kui-Hian, Lewis, Basil S., Van Mieghem, Walter, Lip, Gregory Y.H., Kim, Jae Hyung, Lanas-Zanetti, Fernando, Gonzalez-Hermosillo, Antonio, Dans, Antonio L., Munawar, Muhammad, O'Donnell, Martin, Lawrence, John, Lewis, Gayle, Afzal, Rizwan, Yusuf, Salim·2011·New England Journal of Medicine

DOI 10.1056/nejmoa1007432

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Abstract

BACKGROUND: Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients. METHODS: In a double-blind study, we randomly assigned 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mg per day), to determine whether apixaban was superior. The mean follow up period was 1.1 years. The primary outcome was the occurrence of stroke or systemic embolism. RESULTS: Before enrollment, 40% of the patients had used a vitamin K antagonist. The data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI], 0.32 to 0.62; P<0.001). The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (hazard ratio, 0.79; 95% CI, 0.62 to 1.02; P=0.07). There were 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (hazard ratio with apixaban, 1.13; 95% CI, 0.74 to 1.75; P=0.57); there were 11 cases of intracranial bleeding with apixaban and 13 with aspirin. The risk of a first hospitalization for cardiovascular causes was reduced with apixaban as compared with aspirin (12.6% per year vs. 15.9% per year, P<0.001). The treatment effects were consistent among important subgroups. CONCLUSIONS: In patients with atrial fibrillation for whom vitamin K antagonist therapy was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00496769.).

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Self-citation
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“Apixaban In the Apixaban in Patients with Atrial Fibrillation (AVERROES) trial, 5599 patients with AF deemed unsuitable for VKA therapy were randomly assigned to the factor Xa inhibitor apixaban 5 mg twice/day or aspirin 81–324 mg once/ day.(36) Reasons for unsuitability included labile INR readings (17%), inability t…”
Method
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BackgroundMethodInfluential
Baseline characteristics in stroke patients with atrial fibrillation: clinical trials versus clinical practice
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Background
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“Of these, dabigatran [13], rivaroxaban [14], and apixaban [15, 16] have completed phase III clinical trial programmes for stroke prevention in AF, with the first two already approved by key regulatory agencies worldwide.”
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“However, most major randomized controlled trials of NOACs have excluded patients with hemoglobin <10 g/ dL.(11,13,14,16) In addition, there is no specific recommendation for anticoagulant therapy in anemic patients with AF and hemoglobin <10 g/dL in current guidelines.”
Background
The Effects of Clarithromycin on the Pharmacokinetics of Apixaban in Healthy Volunteers: A Single-Sequence Crossover Study
Merali, S. J., Byon, W., Myers, E., Li, X., Marchisin, D., & Murthy, B. (2019) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-019-00348-2 · Cited by 19
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“Anticoagulation is essential for preventing stroke in AF [3, 4], while antiplatelet therapy plays a key role in the prevention of recurrent ischemic events in CAD [5].”
Background
Implications of new anticoagulants in primary practice
Perez, A., Eraso, L. H., & Merli, G. J. (2013) · International Journal of Clinical Practice · doi:10.1111/ijcp.12023 · Cited by 19
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“Apixaban was also compared with aspirin in patients who are unsuitable for oral anticoagulation in the AVERROES trial [13].”
Method
Clinical strategies for selecting oral anticoagulants in patients with atrial fibrillation
Pokorney, S. D., Sherwood, M. W., & Becker, R. C. (2013) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-013-0956-2 · Cited by 18
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Management of Atrial Fibrillation
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“4%/year in both groups).(25) This trial has been criticized because of the lack of standardization of the aspirin dose and the use of enteric-coated”
Background
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Toschi, V., & Lettino, M. (2011) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2011.04001.x · Cited by 19
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“In the AVERROES trial (apixaban versus acetylsalicylic acid to prevent stroke in AF patients who have failed or are unsuitable for VKA treatment), apixaban was compared to aspirin alone for stroke prevention [17].”
Background
Embolic Stroke, Atrial Fibrillation, and Microbleeds
Diener, H., Selim, M. H., Molina, C. A., & Greenberg, S. M. (2016) · Stroke · doi:10.1161/strokeaha.115.011150 · Cited by 19
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“Recently, non-vitamin K antagonist oral anticoagulants (NOAC) have become available [14–17], and the convenience has been improved [18].”
Background
How the direct oral anticoagulant apixaban affects hemostatic parameters. Results of a multicenter multiplatform study
Tripodi, A., Padovan, L., Testa, S., Legnani, C., Chantarangkul, V., Scalambrino, E., Ludovici, S., Bassi, L., & Peyvandi, F. (2014) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2014-0531 · Cited by 19
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“One of the major clinical benefits of apixaban is that it is associated with fewer intracranial hemorrhages, the most devastating complication of VKA use [46].”
Background
Influence of Competing Risks on Estimating the Expected Benefit of Warfarin in Individuals with Atrial Fibrillation Not Currently Taking Anticoagulants: The Anticoagulation and Risk Factors in Atrial Fibrillation Study
Ashburner, J. M., Go, A. S., Chang, Y., Fang, M. C., Fredman, L., Applebaum, K. M., & Singer, D. E. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14516 · Cited by 19
“More recently, the Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment trial demonstrated 55% lower stroke risk with the oral anticoagulant apixaban than with aspirin but with only slightly lower nonstroke mortality…”
Background
Quick reference guide to apixaban
Hurst, K. V., O'Callaghan, J. M., & Handa, A. I. (2017) · Vascular Health and Risk Management · doi:10.2147/vhrm.s121944 · Cited by 20
“07).(11) Efficacy in the prevention of VTE VTE is a significant issue in patients with reduced mobility, particularly after surgery.”
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Apixaban
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“It is especially remarkable that patients with the highest risks for stroke, to a large part driven by high age, more often received ASA compared to patients with lower risks, since ASA is much less effective than oral anticoagulation treatment for the prevention of stroke without offering significant benefits regardi…”
Background
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Stroke prevention in AF
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Apixaban: A Review of its Use for Reducing the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation
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BackgroundMethodResultInfluential
Antiplatelet therapy in prevention of cardio- and venous thromboembolic events
Steinhubl, S. R., Eikelboom, J. W., Hylek, E. M., Dauerman, H. L., Smyth, S. S., & Becker, R. C. (2013) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-013-1023-8 · Cited by 18
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Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation
Lerario, M. P., Gialdini, G., Lapidus, D. M., Shaw, M. M., Navi, B. B., Merkler, A. E., Lip, G. Y. H., Healey, J. S., & Kamel, H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145579 · Cited by 18
“[2] Non-vitamin K antagonist oral anticoagulant drugs such as apixaban may not significantly increase the risk of intracranial hemorrhage compared with aspirin,[4] but the use of any antithrombotic therapy in patients with AF is associated with a 0.”
Background
Relative effects of different non-vitamin K antagonist oral anticoagulants on global thrombotic status in atrial fibrillation
Farag, M., Niespialowska-Steuden, M., Okafor, O., Artman, B., Srinivasan, M., Khan, A. M., Sullivan, K. R., Wellsted, D. M., & Gorog, D. A. (2016) · Platelets · doi:10.3109/09537104.2016.1158402 · Cited by 18
Gender and AF: Differences and Disparities
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“Warfarin 1.4 2.1 Connolly et al.46 RELY 2009 12,091 7,705 (63.7”
Influential
Pleiotropic effects of the hemostatic system
Kremers, B., Cate, H. T., & Spronk, H. M. H. (2018) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.14161 · Cited by 18
Association of preceding antithrombotic therapy in atrial fibrillation patients with ischaemic stroke, intracranial haemorrhage, or gastrointestinal bleed and mortality
Komen, J. J., Forslund, T., Mantel-Teeuwisse, A. K., Klungel, O. H., von Euler, M., Braunschweig, F., Wallén, H., & Hjemdahl, P. (2019) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvz063 · Cited by 18
“Non-vitamin K oral anticoagulants (NOACs) have been shown to be at least as safe and efficacious as warfarin,(1) and superior to aspirin in preventing stroke in patients with atrial fibrillation (AF).(2) In particular, NOACs markedly reduce the risk for intracranial haemorrhage compared to warfarin.”
Background
Comparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study
Li, X., Pathadka, S., Man, K. K. C., Ng, V. W. S., Siu, C., Wong, I. C. K., Chan, E. W., & Lau, W. C. Y. (2020) · Drug Safety · doi:10.1007/s40264-020-00961-0 · Cited by 18
Residual risks of ischaemic stroke and systemic embolism among atrial fibrillation patients with anticoagulation: large-scale real-world data (F-CREATE project)
Maeda, T., Nishi, T., Funakoshi, S., Tada, K., Tsuji, M., Satoh, A., Kawazoe, M., Yoshimura, C., & Arima, H. (2020) · Heart · doi:10.1136/heartjnl-2020-317299 · Cited by 18
Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion
Doijiri, R., Yamagami, H., Morimoto, M., Iwata, T., Hashimoto, T., Sonoda, K., Yamazaki, H., Koge, J., Kimura, N., & Todo, K. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.580572 · Cited by 18
“Moreover, ischemic stroke patients with AF have higher recurrence rates than those without (3); however, oral anticoagulants substantially reduce the risk of recurrent stroke compared to antiplatelet therapy (4, 5).”
Background
Gender Differences in Anticoagulation and Antithrombotic Therapy
Rauch, U. (2012) · Handbook of experimental pharmacology · doi:10.1007/978-3-642-30726-3_23 · Cited by 18
Pharmacokinetics and pharmacodynamics of the factor Xa inhibitor apixaban after oral and intravenous administration to cats
Myers, J. A., Wittenburg, L. A., Olver, C. S., Martinez, C. M., & Bright, J. M. (2015) · American Journal of Veterinary Research · doi:10.2460/ajvr.76.8.732 · Cited by 18
Direct oral anticoagulants: integration into clinical practice
Cowell, R. P. W. (2014) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2013-132474 · Cited by 19
Influence of apixaban on antifactor Xa levels in a patient with acute kidney injury
Wendte, J., Voss, G. D., & VanOverschelde, B. (2016) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp150360 · Cited by 18
“5 mg/dL or a creatinine clearance of <25 mL/min (calculated using the Cockcroft–Gault equation) were excluded from clinical trials.(3,4) The American College of Cardiology, the American Heart Association, and the Heart Rhythm Society recommend the use of warfarin over apixaban for the prevention of embolic events from…”
Cost Effectiveness of Apixaban versus Warfarin or Aspirin for Stroke Prevention in Patients with Atrial Fibrillation: A Greek Perspective
Athanasakis, K., Boubouchairopoulou, N., Karampli, E., Tarantilis, F., Savvari, P., Bilitou, A., & Kyriopoulos, J. E. (2016) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-016-0204-1 · Cited by 18
Left atrial appendage closure: outcomes and challenges
Suradi, H. S., & Hijazi, Z. M. (2016) · Netherlands Heart Journal · doi:10.1007/s12471-016-0929-0 · Cited by 18
“Furthermore, AF patients with concomitant coronary artery stents present significant challenges as the addition of oral anticoagulant to dual antiplatelet therapy increases the risk of bleeding and the use of antiplatelet therapy alone does not provide effective stroke prevention [12].”
Background
Understanding and Managing Atrial Fibrillation in Patients with Kidney Disease.
Khouri, Y. S., Stephens, T., Ayuba, G. A., Al‐Ameri, H., Juratli, N., & McCullough, P. A. (2015) · Europe PMC (PubMed Central) · doi:10.4022/jafib.1069 · Cited by 18
Novel Oral Anticoagulants for Atrial Fibrillation
Hankey, G. J., & Eikelboom, J. W. (2013) · Current Atherosclerosis Reports · doi:10.1007/s11883-013-0344-6 · Cited by 17
Medical costs in the US of clinical events associated with oral anticoagulant (OAC) use compared to warfarin among non-valvular atrial fibrillation patients ≥75 and <75 years of age, based on the ARISTOTLE, RE-LY, and ROCKET-AF trials
Deitelzweig, S., Amin, A., Jing, Y., Makenbaeva, D., Wiederkehr, D., Lin, J., & Graham, J. (2013) · Journal of Medical Economics · doi:10.3111/13696998.2013.826664 · Cited by 17
Antithrombotic treatment and intracerebral haemorrhage: between Scylla and Charybdis
Hofmeijer, J., Kappelle, L. J., & Klijn, C. J. M. (2015) · Practical Neurology · doi:10.1136/practneurol-2015-001104 · Cited by 17
A novel approach indirectly comparing benefit–risk balance across anti-thrombotic therapies in patients with atrial fibrillation
Dogliotti, A., & Giugliano, R. P. (2015) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvu007 · Cited by 16
Atrial Fibrillation in the Setting of Acute Pneumonia: Not a Secondary Arrhythmia
Maisano, A., Vitolo, M., Imberti, J. F., Bonini, N., Albini, A., Valenti, A. C., Sgreccia, D., Mantovani, M., Malavasi, V. L., & Boriani, G. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2305176 · Cited by 17
Reduced dose direct oral anticoagulants compared with warfarin with high time in therapeutic range in nonvalvular atrial fibrillation
Jansson, M., Själander, S., Sjögren, V., Björck, F., Renlund, H., Norrving, B. G., & Själander, A. (2023) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-022-02763-w · Cited by 16
Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes
Rydén, L., estable, G. D. T. D. L. S. E. D. C. S. D. Y. T. D. L. C. I., Grant, P. J., Anker, S. D., Berne, C., Cosentino, F., Danchin, N., Deaton, C., Escaned, J., Hammes, H. P., et al. (2014) · Revista Española de Cardiología · doi:10.1016/j.recesp.2013.10.015 · Cited by 20
Risk versus Benefit of Non-Vitamin K Dependent Anticoagulants Compared to Warfarin for the Management of Atrial Fibrillation in the Elderly
Ogbonna, K. C., & Jeffery, S. M. (2013) · Drugs & Aging · doi:10.1007/s40266-013-0075-y · Cited by 17
Left Atrial Appendage Closure with Transcatheter-Delivered Devices
Whisenant, B. K., & Weiß, P. J. (2014) · Interventional Cardiology Clinics · doi:10.1016/j.iccl.2014.01.002 · Cited by 17
Dabigatran: A Cause of Hematologic Emergency
Lal, Y., & Heukelom, J. V. (2012) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e31826c5a56 · Cited by 17
Under-reporting of venous and arterial thrombotic events in randomized clinical trials: a meta-analysis
Stuijver, D. J. F., Romualdi, E., van Zaane, B., Bax, L., Buller, H. R., Gerdes, V. E. A., & Squizzato, A. (2014) · Internal and Emergency Medicine · doi:10.1007/s11739-014-1168-2 · Cited by 17
The emergence of factor Xa inhibitors for the treatment of cardiovascular diseases: a patent review
Pinto, D. J. P., Qiao, J. X., & Knabb, R. M. (2012) · Expert Opinion on Therapeutic Patents · doi:10.1517/13543776.2012.680438 · Cited by 17
Dosing of Target-Specific Oral Anticoagulants in Special Populations
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Stroke risk stratification scores in atrial fibrillation: current recommendations for clinical practice and future perspectives
Durrant, J., Lip, G. Y. H., & Lane, D. A. (2012) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.12.161 · Cited by 17
Cost-effectiveness of non-vitamin K antagonist oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a systematic and qualitative review
Liberato, N. L., & Marchetti, M. (2016) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.2016.1147351 · Cited by 17
“Apixaban has been also compared to acetylsalicylic acid (ASA) in NVAF patients who failed or were unsuitable for VKA in the AVERROES trial [14]: the study was stopped early because of a clear benefit in favor of Apixaban (55% reduction of IS with similar major bleeding rate).”
Result
Antithrombotic treatment for newly diagnosed atrial fibrillation in relation to patient age: the GLORIA-AF registry programme
Mazurek, M., Halperin, J. L., Huisman, M. V., Diener, H., Dubner, S., Sheng, C., Rothman, K. J., Healey, J. S., Teutsch, C., Paquette, M., et al. (2019) · EP Europace · doi:10.1093/europace/euz278 · Cited by 17
Treatment of older patients with atrial fibrillation by morbidity burden
Rasmussen, P. V., Pallisgaard, J. L., Hansen, M. L., Gislason, G., Torp-Pedersen, C. T., Ruwald, M. H., Alexander, K. P., Lópes, R. D., Al‐Khatib, S. M., & Dalgaard, F. (2020) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcaa070 · Cited by 17
Stroke Prevention: Little-Known and Neglected Aspects
Azarpazhooh, M. R., Bogiatzi, C., & Spence, J. D. (2021) · Cerebrovascular Diseases · doi:10.1159/000515829 · Cited by 18
Cardiac manifestations in hyperthyroidism
Navarro, A., Cruz-Cuevas, J. D., Ordoñez, N. A., Giral, H., Palmezano, J., Bolívar-Mejía, A., Santana, Q., Fernandez, R., Durango, L. F., Saldarriaga, C., et al. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2304136 · Cited by 18
“However, currently, the ability to reduce embolic events with ASA is not optimal compared to oral anticoagulants, maintaining a bleeding profile similar to these [97].”
Background
Individualized approaches to thromboprophylaxis in atrial fibrillation
Ziff, O. J., & Camm, A. J. (2015) · American Heart Journal · doi:10.1016/j.ahj.2015.10.021 · Cited by 18
Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis
Marcolino, M. S., Polanczyk, C. A., Bovendorp, A. C. C., Marques, N. S., da Silva, L. A., Turquia, C. P. B., & Ribeiro, A. L. P. (2016) · Sao Paulo Medical Journal · doi:10.1590/1516-3180.2016.0019260216 · Cited by 17
Impact of Antiplatelets and Anticoagulants on the Prognosis of Intracerebral Hemorrhage
Hokari, M., Shimbo, D., Asaoka, K., Uchida, K., & Itamoto, K. (2017) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2017.05.016 · Cited by 17
Anesthesia for Cardiac Ablation
Fujii, S., Zhou, J. R., & Dhir, A. K. (2017) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2017.12.039 · Cited by 17
Use of insertable cardiac monitors for the detection of atrial fibrillation in patients with cryptogenic stroke in the United States is cost-effective
Maervoet, J., Bossers, N., Borge, R. P., Hilpert, S. T., van Engen, A., & Smala, A. M. (2019) · Journal of Medical Economics · doi:10.1080/13696998.2019.1663355 · Cited by 17
Decision making for oral anticoagulants in atrial fibrillation: The ATA-AF study
Gussoni, G., Pasquale, G. D., Vescovo, G., Gulizia, M. M., Mathieu, G., Scherillo, M., Panuccio, D., Lucci, D., Nozzoli, C., Fabbri, G., et al. (2013) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2013.04.008 · Cited by 16
Direct thrombin inhibitors and factor Xa inhibitors in patients with cerebrovascular disease
Morales‐Vidal, S., Schneck, M. J., Flaster, M. S., & Biller, J. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.185 · Cited by 16
Nuevos anticoagulantes orales en pacientes con enfermedad renal crónica
Belmar, L., de Francisco, Á. L. M., da Silva, J. B., Espinoza, L. G., & Fresnedo, G. F. (2016) · Nefrología · doi:10.1016/j.nefro.2016.08.006 · Cited by 17
Apixaban Single‐Dose Pharmacokinetics, Bioavailability, Renal Clearance, and Pharmacodynamics Following Intravenous and Oral Administration
Frost, C. E., Merali, S. J., Shenker, A., Barrett, Y. C., & LaCreta, F. P. (2021) · Clinical Pharmacology in Drug Development · doi:10.1002/cpdd.990 · Cited by 17
Direct Oral Anticoagulant Use in Older Adults with Atrial Fibrillation: Challenges and Solutions
Bhandari, M., Pradhan, A. K., Vishwakarma, P., Renzo, L. D., Iellamo, F., Ali, W., & Perrone, M. A. (2025) · European Cardiology Review · doi:10.15420/ecr.2024.17 · Cited by 20
“50 The median duration of follow-up was 1.5 years, the mean age was approximately 70 years and the primary endpoint was a composite of stroke or SE.”
Influential
New oral antithrombotics: focus on dabigatran, an oral, reversible direct thrombin inhibitor for the prevention and treatment of venous and arterial thromboembolic disorders
Winchester, C. (2012) · Vascular Health and Risk Management · doi:10.2147/vhrm.s26482 · Cited by 16
“2% per year) and similar rates of intracranial hemorrhage (11 versus 13 events).(89) The ARISTOTLE trial included patients with atrial fibrillation and at least one additional risk factor for stroke.”
Background
Prevention of Venous Thromboembolism with New Oral Anticoagulants versus Standard Pharmacological Treatment in Acute Medically Ill Patients
Albertsen, I. E., Larsen, T. B., Rasmussen, L. H., Overvad, T. F., & Lip, G. Y. H. (2012) · Drugs · doi:10.2165/11635630-000000000-00000 · Cited by 16
“Furthermore, apixaban has an established effect for the prevention of stroke in patients with atrial fibrillation.([26,27]) Thus far, no phase II studies have been carried out with new OACs in medically ill patients.”
Actualización detallada de las guías de la ESC para el manejo de la fibrilación auricular de 2012
Camm, A. J., Lip, G. Y. H., Caterina, R. D., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., Kirchhof, P. F., Bax, J. J., Baumgartner, H., et al. (2012) · Revista Española de Cardiología · doi:10.1016/j.recesp.2012.11.001 · Cited by 16
Periprocedural Management of Oral Anticoagulation in Patients With Atrial Fibrillation: Approach in the Era of New Oral Anticoagulants
Healey, J. S., & Brambatti, M. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.02.021 · Cited by 16
Antithrombotic and antiplatelet therapy in TAVI patients: a fallow field?
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Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium
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Newer Oral Anticoagulant Agents: A New Era in Medicine
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Role of Emerging Antithrombotic Therapy in the Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation
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“Apixaban was evaluated as a stroke prophylaxis agent in the AVERROES (Apixaban Versus Acetylsalicylic Acid to Prevent Strokes) trial: a double-blinded, randomized, multicenter, phase III trial of 5599 patients in 36 countries.([27,37]) The study focused on AF patients (mean CHADS2 score of 2) who had at least one risk…”
BackgroundMethodResultInfluential

Authors: Connolly, S. J., Eikelboom, J., Joyner, C., Diener, H.-C., Hart, R., Golitsyn, S., Flaker, G., Avezum, A., Hohnloser, S. H., Diaz, R., Talajic, M., Zhu, J., Pais, P., Budaj, A., Parkhomenko, A., Jansky, P., Commerford, P., Tan, R. S., Sim, K.-H., Lewis, B. S., Van Mieghem, W., Lip, G. Y. H., Kim, J. H., Lanas-Zanetti, F., Gonzalez-Hermosillo, A., Dans, A. L., Munawar, M., O'Donnell, M., Lawrence, J., Lewis, G., Afzal, R., & Yusuf, S.
Affiliations: Population Health Research Institute (CA)
ORCID: Connolly, Stuart J.
Eikelboom, John
Hart, Robert
Hohnloser, Stefan H.
Talajic, Mario
Zhu, Jun
Budaj, Andrzej
Parkhomenko, Alexander
Tan, Ru San
Lewis, Basil S.
Lip, Gregory Y.H.
O'Donnell, Martin
Lawrence, John
Yusuf, Salim
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2011-03-03
Volume: 364
Issue: 9
Pages: 806-817
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1007432
OpenAlex: W2149388786
Cited by: 2,483
References: 23
Citations by year: 2026: 45 · 2025: 54 · 2024: 99 · 2023: 70 · 2022: 71 · 2021: 111 · 2020: 111 · 2019: 119 · 2018: 139 · 2017: 172 · 2016: 215 · 2015: 239 · 2014: 249 · 2013: 310 · 2012: 303
FWCI: 223.65
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
UnissResearch (Università degli Studi di Sassari) (submittedVersion)
Omeka S (Universidad de La Frontera) (submittedVersion)
Funders: Bristol-Myers Squibb
Eli Lilly and Company
Pfizer
AstraZeneca
GlaxoSmithKline
Sanofi
Hamilton Health Sciences
McMaster University
Astellas Pharma
Servier
Institut de Cardiologie de Montréal
St. Jude Medical
Bayer Vital
Cilag
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Keywords: apixaban, atrial fibrillation, factor Xa inhibitors, aspirin, stroke prevention, systemic embolism, vitamin K antagonists, major bleeding, intracranial hemorrhage, cardiovascular hospitalization, oral anticoagulation, early trial termination, cardiovascular mortality, cardiovascular risk stratification, subgroup analysis, bleeding risk stratification
MeSH terms: Aged, Aged, 80 and over, Aspirin, Atrial Fibrillation, Double-Blind Method, Embolism, Female, Fibrinolytic Agents, Hemorrhage, Humans, Male, Middle Aged, Pyrazoles, Pyridones, Risk Factors, Proportional Hazards Models, Stroke, Factor Xa Inhibitors

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Apixaban in Patients with Atrial Fibrillation

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