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The Effects of Apixaban on Hospitalizations in Patients With Different Types of Atrial Fibrillation: Insights From the AVERROES Trial
Study Questions:
Does apixaban reduce hospitalizations in patients with atrial fibrillation (AF)?
Methods:
This was a post-hoc analysis of a randomized trial that compared apixaban to aspirin in 5,599 patients with AF (paroxysmal in 1,512, persistent in 1,117, permanent in 2,908) who were not suitable candidates for treatment with warfarin. The primary endpoint of the study was the effect of apixaban on cardiovascular and noncardiovascular hospitalizations.
Results:
The hospitalization rate during a mean of 1.1 years of follow-up was significantly lower in the apixaban group (12.3%/year) than in the aspirin group (15.4%). Cardiovascular and noncardiovascular hospitalizations were 20% and 16% lower in the apixaban group, respectively. Among the cardiovascular hospitalizations, the principal difference between the two groups was hospitalizations for stroke (1.3%/year vs. 2.9%/year in the aspirin and apixaban groups, respectively). There were no interactions between the effect of apixaban on hospitalizations and the type of AF. The only independent predictor of lower cardiovascular hospitalizations was apixaban therapy. The strongest independent predictor of mortality was the need for cardiovascular hospitalization (hazard ratio, 3.9).
Conclusions:
The authors concluded that patients with AF treated with apixaban for stroke prevention are less likely to require hospitalization than patients treated with aspirin.
Perspective:
Aspirin has little effect on the stroke rate in patients with AF, and the >2-fold higher hospitalization rate for strokes in the aspirin group in this study provides confirmatory evidence. The ACTIVE A trial showed that aspirin plus clopidogrel prevents strokes more effectively than aspirin. Therefore, combination antiplatelet therapy should be used in AF patients who cannot be treated with an anticoagulant.
Keywords: Stroke, Follow-Up Studies, Platelet Aggregation Inhibitors, Warfarin, Ticlopidine, Pyrazoles, Blood Coagulation, Pyridones, Hospitalization, Atrial Flutter
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