Abstract 13026: Apixaban in Patients with Atrial Fibrillation and Prior Coronary Artery Disease: Insights from the ARISTOTLE Trial
Background: Patients with atrial fibrillation (AF) and coronary artery disease (CAD) are at high risk for ischemic and bleeding events, and warfarin is known to reduce coronary events. We aimed to assess the effects of apixaban compared with warfarin in patients with prior CAD.
Methods: In the double-blind ARISTOTLE trial, 18,201 patients with AF and an additional risk factor for stroke were randomized to apixaban 5 mg twice daily or warfarin (target INR 2.0 to 3.0). In this analysis, we investigated outcomes in patients with and without prior CAD.
Results: Of the study patient population, 6,639 (36.5%) patients had prior CAD. Patients with prior CAD were more often male and have prior stroke, diabetes and hypertension compared with patients without prior CAD. Patient with prior CAD were more likely to be on aspirin at baseline (42.2% vs 24.5%, p<0.001) when compared with patients without prior CAD. The table shows that there were consistently lower rates of stroke or systemic embolism, major bleeding, all-cause mortality, and intracranial bleeding with apixaban than with warfarin in patients with and without CAD (P-values for interactions non-significant).
Conclusion: In patients with atrial fibrillation, apixaban prevents stroke or systemic embolism, causes less bleeding and death compared with warfarin. These treatment effects were consistent in patients with and without a history of CAD.
- © 2012 by American Heart Association, Inc.