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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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Abstract

The direct factor Xa inhibitor apixaban (Eliquis®) has predictable pharmacodynamics and pharmacokinetics and does not require routine anticoagulation monitoring. This article reviews the efficacy and tolerability of oral apixaban to reduce the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF). In the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial in patients with AF and at least one additional risk factor for stroke, apixaban recipients were significantly less likely than warfarin recipients to experience stroke or systemic embolism, major bleeding or death; the beneficial effects of treatment with apixaban versus warfarin were generally maintained across various patient subgroups. Apixaban recipients also had a significantly lower risk of intracranial haemorrhage than warfarin recipients. In the AVERROES (Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in Atrial Fibrillation Patients who have Failed or are Unsuitable for Vitamin K Antagonist Therapy) trial in patients with AF and at least one additional risk factor for stroke for whom vitamin K antagonist therapy was unsuitable, apixaban was associated with a significantly lower risk of stroke or systemic embolism than aspirin, without an increase in the risk of major bleeding. In conclusion, although longer-term efficacy and safety data are needed, apixaban is an important new option for use in patients with nonvalvular AF to reduce the risk of stroke or systemic embolism.

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The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the author on the basis of scientific and editorial merit.

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    Gillian M. Keating

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The manuscript was reviewed by: P.C. Deedwania, School of Medicine, University of California at San Francisco, Fresno, CA, USA; H.-C.Diener, Department of Neurology and Stroke Center, University Hospital Essen, Essen, Germany; S. Husted, Department of Cardiology, Århus University Hospital, Århus, Denmark; G.Y.H. Lip, University of Birmingham Centre for Cardiovascular Science, City Hospital, Birmingham, UK; J. López-Sendón, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain; W. Van Mieghem, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.

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Keating, G.M. Apixaban: A Review of its Use for Reducing the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation. Drugs 73, 825–843 (2013). https://doi.org/10.1007/s40265-013-0063-x

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