Clinical experience with apixaban in atrial fibrillation: implications of AVERROES

Abstract:

Atrial fibrillation is an extremely common arrhythmia, which substantially, increases the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism, is therefore an important part of the management of atrial fibrillation. Guidelines until now, have recommended, that patients with atrial fibrillation receive some form of antithrombotic, therapy, ie, a vitamin K antagonist or aspirin, with a preference for anticoagulants in most, cases. However, current treatments are suboptimal, and despite the recommendations, many, patients do not receive adequate thromboprophylaxis, because they are considered, for various, reasons, “unsuitable” to receive a vitamin K antagonist. In this patient population, apixaban, a, new oral anticoagulant inhibiting activated coagulation factor X, administered in fixed doses, and without anticoagulation, monitoring, has undergone testing against aspirin in the recently, published AVERROES trial. This paper addresses the strengths and limitations of this trial and, the practical relevance of the new clinical information it provides.

Keywords::

• atrial fibrillation
• apixaban
• thromboprophylaxis