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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe oral direct factor Xa inhibitor apixaban was superior to aspirin therapy for the reduction of stroke or systemic embolism risk in patients with atrial fibrillation who were unsuitable for vitamin K antagonist therapy according to the phase III Apixaban versus Acetylsalicylic Acid to Prevent Strokes [AVERROES; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00496769\u0026amp;atom=%2Fspmdc%2F10%2F8%2F14.atom\u0022\u003ENCT00496769\u003C\/a\u003E] trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe oral direct factor Xa inhibitor apixaban was superior to aspirin (ASA) therapy for the reduction of stroke or systemic embolism risk in patients with atrial fibrillation (AF) who were unsuitable for vitamin K antagonist (VKA) therapy. The phase III Apixaban versus Acetylsalicylic Acid to Prevent Strokes (AVERROES; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00496769\u0026amp;atom=%2Fspmdc%2F10%2F8%2F14.atom\u0022\u003ENCT00496769\u003C\/a\u003E) trial was terminated early at the suggestion of the Data Monitoring Committee due to clear evidence of efficacy at the predefined interim analysis in May 2010. Stuart Connolly, MD, Population Health Research Institute, Hamilton, Ontario, Canada, discussed results from the preliminary analysis of AVERROES and the clinical implications of this study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAF presents a high risk of stroke, which can be offset by the use of VKA therapy. However, this regimen is unsuitable for many patients because of increased bleeding risk, compliance issues, and difficulties that are related to anticoagulation monitoring or control. Therefore, a safe, easy-to-use alternative to VKA therapy is warranted. Apixaban offers a possible antithrombotic solution to those who are unable to take VKA, with the added advantages of a 12-hour half-life, multiple excretion pathways (25% renal), and no routine coagulation monitoring requirements.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAVERROES was a double-blind, randomized, multicenter, international, trial that included 5600 patients with AF and at least one risk factor for stroke who were unsuitable candidates for VKA therapy. Patients were randomized to receive either apixaban (5 mg twice daily or 2.5 mg twice daily in selected patients; n=2809) or ASA (81\u2013324 mg daily, with 91% receiving \u2264162 mg daily; n=2791). The patients were well matched at baseline. The mean patient age was 70 years, and median follow-up was 1 year. The primary endpoint was the composite of stroke or systemic embolic event (SEE), and the primary safety endpoint was major hemorrhage. Secondary endpoints included a composite of stroke, SEE, myocardial infarction or vascular death, and total death.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPreliminary data revealed that the incidence of stroke or SEE was significantly lower in the apixaban group compared with the ASA group (RR, 0.46; 95% CI, 0.33 to 0.64; p\u0026lt;0.001). Apixaban reduced the incidence of stroke by \u0026gt;50% compared with ASA (1.5% for the apixaban group vs 3.3% for ASA; p\u0026lt;0.001), without a significant increase in major bleeding. The rate of major bleeding was similar between the two groups (hemorrhagic stroke was 0.2% for both groups). The composite secondary outcome and rate of total death also favored apixaban over ASA therapy.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EApixaban appeared to be safe and well tolerated compared with ASA, without evidence of liver toxicity. The reductions in stroke and SEE risk occurred without a significant increase in bleeding. Dr. Connolly concluded that for every 1000 patients who were treated with apixaban rather than ASA for 1 year, 18 strokes, 10 deaths, and 31 cardiovascular hospitalizations would be prevented at the cost of 2 major bleeds. These findings demonstrate that apixaban is appropriate for stroke prevention in AF patients who are unsuitable candidates for VKA therapy.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/8\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmotd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}