Author + information
- Sigrun Halvorsen,
- Lars Wallentin,
- Hongqiu Yang,
- Raffaele De Caterina,
- Cetin Erol,
- David Garcia,
- Christopher B. Granger,
- Michael Hanna,
- Claes Held,
- Steen Husted,
- Elaine Hylek,
- Petr Jansky,
- Renato Lopes,
- Witold Ruzyllo,
- Laine Thomas and
- Dan Atar
The risk of stroke in patients with atrial fibrillation (AF) increases with age. In the ARISTOTLE trial, apixaban as compared with warfarin reduced the rate of stroke, death and bleeding. We evaluated these and other pre-specified outcomes in relation to age.
18201 patients with AF and a raised risk of stroke were randomized to warfarin or apixaban 5 mg b.d. with dose reduction to 2.5 mg b.d. in 831 patients with two of the following criteria: age > 80 years, body weight <60 kg or creatinine > 1.5 mg/dl. We used Cox models to compare outcomes in relation to patients age during 1.8 years mean follow-up.
Of the trial population, 30% were < 65 years, 39% were 65 to <75, and 31% were ≥75 years. The rates of both cardiovascular events and bleeding were higher in the older age groups (p<0.001). Apixaban was more effective than warfarin in preventing stroke and reducing mortality and associated with less major bleeding, less total bleeding and less ICH across all age groups (Figure). No significant interaction with apixaban dose was found with respect to major outcomes. Results were also consistent for the 13% of patients ≥80 yrs.
The benefits of apixaban versus warfarin were consistent in patients with AF regardless of age. Owing to the higher risk at older age, the absolute benefits of apixaban were even greater in the older patient group. The ARISTOTLE trial was funded by Bristol-Myers Squibb and Pfizer, Inc. www.ClinicalTrials.govnumber NCT00412984
Figure: Effect of apixaban vs warfarin
Oral Contributions West, Room 3009
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Joint Session of the Heart Rhythm Society and the American College of Cardiology: Anticoagulation in Atrial Fibrillation -Management Questions with New Anticoagulants
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 914-4
- 2013 American College of Cardiology Foundation