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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\u003EThis article discusses the results of the 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%2F11%2F1%2F15.2.atom\u0022\u003ENCT00496769\u003C\/a\u003E], which revealed clear evidence of a clinically important reduction in stroke and systemic embolism with apixaban over aspirin in patients with atrial fibrillation who were intolerant or otherwise considered unsuitable for vitamin K antagonist therapy.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular DiseaseArrhythmias Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHans-Christoph Diener, MD, University Hospital, Essen, Germany, presented the results of the 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%2F11%2F1%2F15.2.atom\u0022\u003ENCT00496769\u003C\/a\u003E) Study on behalf of the steering committee and the investigators. The study revealed clear evidence of a clinically important reduction in stroke and systemic embolism (SE) with apixaban over aspirin in patients with atrial fibrillation (AF) who were intolerant or otherwise considered unsuitable for vitamin K antagonist (VKA) therapy.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPatients with AF have an increased risk of stroke, and although VKA therapy is effective in reducing stroke, it is complex to manage and is associated with an increased risk of hemorrhage. For patients who are unsuitable for VKA therapy, the only alternative treatment is aspirin, which provides insufficient protection from stroke in high-risk patients (RR, 22%). Apixaban is an investigational oral anticoagulant that selectively inhibits factor Xa. It is efficacious as prophylaxis for venous thromboembolism and has a favorable risk-benefit ratio compared with low-molecular-weight heparin.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe purpose of the AVERROES Study was to evaluate apixaban for the prevention of stroke or SE patients with AF who are at risk for stroke and unsuitable for VKA therapy. AVERROES was a double-blind, randomized, active comparator trial that compared apixaban with aspirin. Patients with documented AF and at least one risk factor for stroke who were also unsuitable for VKA therapy were randomly assigned to receive either apixaban 5 mg bid (n=2808) or aspirin 81\u2013324 mg per day (n=2791). The primary study outcome was stroke or a systemic embolic event (SEE).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESubjects had a mean age of 70 years, and 59% were men. Approximately 75% of subjects were on aspirin therapy at baseline, and 40% had been on VKA therapy previously but had discontinued its use; 60% were considered unsuitable for VKA therapy. AVERROES was stopped early, based on overwhelming evidence of efficacy against stroke or SE, together with an excellent safety profile. The relative risk reduction in favor of apixaban was 0.45 (95% CI, 0.32 to 0.62; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/1\/15.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Stroke or SEE.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-322035538\u0022 data-figure-caption=\u0022Stroke or SEE.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/1\/15.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/1\/15.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/1\/15.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12229\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EStroke or SEE.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECopyright \u00a9 2011 Massachusetts Medical Society. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EWhen the primary outcome events were assessed separately, there were 49 strokes with apixaban versus 105 with aspirin (RR, 0.46; 95% CI, 0.33 to 0.65; p\u0026lt;0.001) and 2 SEEs with apixaban versus 13 with aspirin (RR, 0.15; 95% CI, 0.03 to 0.68; p=0.01). There was no difference in the secondary outcomes of myocardial infarction, vascular death, or mortality. Hospitalizations for cardiovascular events were significantly lower with apixaban (367 vs 455; p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EApixaban was well tolerated, with no evidence of liver toxicity. There was a small increase in bleeding with apixaban compared with aspirin, but the difference was not significant (RR, 1.13; 95% CI, 0.74 to 1.75; p=0.57). Adverse events were similar in both groups, with the exception of nervous system disorders, which were significantly more common in the aspirin group (6.6%) compared with the apixaban group (3% of patients; p\u0026lt;0.001) [Connolly SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 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\/11\/1\/15.2.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_figures.js?nzn4k2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn4k2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}