Apixaban effective in polypharmacy setting

In continuation of my update on Apixaban

The superiority of apixaban over warfarin in patients with atrial fibrillation is maintained in those taking multiple medications, shows further analysis of the ARISTOTLE trial.

 Apixaban

The researchers found superior efficacy of apixaban against the primary thromboembolic endpoint (stroke or systemic embolism) regardless of the number of drugs patients were taking.

By contrast, the advantage of apixaban over warfarin in terms of major bleeding tended to decline in line with the number of drugs patients were taking. The absolute rate reduction per 100 patient-years with apixaban versus warfarin was 1.28 for patients taking up to five medications, falling to 0.82 and 0.66 for those taking six to eight and more than nine drugs, respectively.

"Importantly, the risk reduction of intracranial bleeding did not diminish with an increasing number of concomitant drugs", write the researchers in The BMJ.

"Therefore, the fact that the relative benefit of apixaban over warfarin appears to diminish across groups is due to other types of major bleeding."

They give the example of major gastrointestinal bleeding, which was significantly reduced with apixaban versus warfarin in patients taking up to five drugs, but not in those taking nine or more drugs.

Polypharmacy was common among the 18,201 ARISTOTLE participants, with 76.5% taking at least five concomitant drugs. Patients' average age rose in line with the number of drugs used, as did their stroke and bleeding risk. Patients taking more drugs also had more cardiovascular comorbidities, and also more neurological, renal, endocrine, musculoskeletal, pulmonary, gastrointestinal and haematological comorbidities.

Rates of the primary thromboembolic and bleeding endpoints rose with the number of drugs taken for patients in the apixaban group as well as those in the warfarin group.

Jeroen Jaspers Focks (Radboud University Nijmegen Medical Centre, the Netherlands) and study co-authors stress that "this increased risk of adverse outcomes should be placed in the context of the association between the number of drug treatments and comorbidities present at baseline, indicating a more frail status of patients with polypharmacy."

The researchers suggest that adjusting for these differences would abolish the relationship between the number of drugs used and safety outcomes, but add that the purpose of the study was to use polypharmacy as a marker of patient frailty.

Moreover, increasing frailty did not significantly influence the efficacy of apixaban against stroke or systemic embolism, with the relative risk versus warfarin being 14% among those taking up to five drugs and 24% in those taking more.

New Blood Thinner May Help Prevent Leg Clots, Study Finds - Drugs.com MedNews

In continuation of my update on apixaban....

We know that, Apixaban (BMS-562247-01, tradename Eliquis) is an anticoagulant for the prevention of venous thromboembolism and venous thromboembolic events. It is a direct factor Xa inhibitor. Apixaban has been available in Europe since May 2012 and was approved for preventing venous thromboembolism after elective hip or knee replacement.^[1] An FDA decision on apixaban for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation was expected on June 28, 2012, but was delayed. It is being developed in a joint venture by Pfizer and Bristol-Myers Squibb.

New Blood Thinner May Help Prevent Leg Clots, Study Finds - Drugs.com MedNews

New oral blood thinners can decrease stroke risk in atrial fibrillation patients without frequent monitoring

In continuation of my update on dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa).

A new generation of blood thinners can reduce the risk of stroke in patients with atrial fibrillation, without requiring frequent monitoring and dietary restrictions.

But special attention must be given to the patient's age, kidney function and other factors before prescribing the new medications, according to a review article by neurologists at Loyola Medicine and Loyola University Chicago Stritch School of Medicine.

The report by Rochelle Sweis, DO and José Biller, MD, is published in the journal Current Treatment Options in Cardiovascular Medicine.

Atrial fibrillation (AFib) is the most common type of irregular heartbeat, and the prevalence is increasing as the population ages. In AFib, electrical signals that regulate the heartbeat become erratic. Instead of beating regularly, the upper chambers of the heart quiver and blood doesn't flow well. Blood clots can form, migrate to the brain and cause strokes. AFib is associated with a fivefold increase in the risk of stroke.

Blood thinning medications decrease the stroke risk by approximately 70 percent. For 60 years physicians have prescribed warfarin (Coumadin) and other blood thinners known as vitamin K antagonists. These medications have been proven to be effective in reducing the risk of blood clots and strokes. But they require continual monitoring and dose adjustments to ensure the drugs thin the blood enough to prevent clots, but not enough to increase the risk of major bleeding. Patients also must restrict their consumption of foods rich in vitamin K, such as spinach, Brussels sprouts, kale, parsley and green tea.

 

Warfarin

The new blood thinners include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). In the right patient population, the new drugs are a safe and effective option for treating atrial fibrillation, Drs. Sweis and Biller write.

Dabigatran         Rivaroxaban (BAY 59-7939)

Apixaban Edoxaban

New oral blood thinners can decrease stroke risk in atrial fibrillation patients without frequent monitoring: A new generation of blood thinners can reduce the risk of stroke in patients with atrial fibrillation, without requiring frequent monitoring and dietary restrictions.

Experimental Drug-apixaban (Eliquis) : Might Beat Aspirin in Preventing Repeat Strokes: Study

An investigational drug called apixaban (Eliquis) appears to be better than aspirin at preventing blood clots in certain patients who have already suffered a stroke or so-called "mini-stroke" due to an abnormal heart rhythm, according to the results of a new study.

For patients with the dangerous irregular heart rhythm known as atrial fibrillation who can't tolerate the standard drug treatment, daily apixaban seems to be more effective at warding off a stroke or blood clot than aspirin, the study found.

More....

FDA Approves Eliquis (apixaban) for the Treatment of Deep Vein Thrombosis and Pulmonary Embolism

In continuation of my update on Apixaban (BMS-562247-01, tradename Eliquis)

Bristol-Myers Squibb Company and Pfizer Inc.  announced the U.S. Food and Drug Administration (FDA) has approved a Supplemental New Drug Application (sNDA) for Eliquis for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy. Combined, DVT and PE are known as VTE. It is estimated that every year, approximately 900,000 Americans are affected by DVT and PE.

FDA Approves Eliquis (apixaban) for the Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Eliquis Receives Positive Opinion from CHMP | News | Drug Discovery and Development Magazine

In continuation of my update on Apixaban
Eliquis Receives Positive Opinion from CHMP | News | Drug Discovery and Development Magazine