May 29, 2023

A paper in the March 25th issue of JACC looks at the effectiveness of apixaban for prevention of stroke in patients undergoing cardioversion for AF. This interview with Greg Flaker, MD, professor of medicine at the University of Missouri, was conducted at ACC.14 in Washington, DC.

We know from aristotle that the pixel ban reduces the risk of stroke and systolic systemic emboli in patients with af and risk factors for stroke compared with warfarin now a paper in the march 25th issue of jack is looking at a slightly different analysis the efficacy and safety of a pixel ban in patients following cardioversion for atrial fibrillation and this

Is insights from the aristotle trial i am with the first author of the paper great dr. gregg flaker professor of medicine at the university of missouri and i guess the first thing we should do is just remind us what did we find in the overall aristotle trial overall aristotle compared with warfarin reduce the risk of stroke or systemic embolism by 21 percent it

Also reduced overall mortality compared with warfarin by 11 percent and major bleeding was reduced by 31 percent so pretty compelling findings in the atrial fibrillation population as a whole now a lot of patients with af end up going for a procedure that is cardioversion then the whole issue becomes a little bit different so you’re doing an analysis of patients

From aristotle who went on to cardioversion that’s correct rick we found about 753 cardioversion attempts there were over 500 patients with some head – or some had three cardia versions and what we were interested in is what was the risk of a cardioversion in a apixaban treated patient compared with a warfarin treated patient we know historically that the risk

Of a stroke or systemic embolism after cardioversion is very low right with warfarin treated we wanted to see if that was also true with the pixum and what did you find virtually no strokes are systemic embolism in the 30 days after cardioversion with the pixi bam and true to form with warfarin also a very low risk so the truth the risk of this are comparable and

They’re low very good any lessons that you want to take away from this a couple things number one is a pixie bomb was given generally for i’d say six months to eight months these are people that have been on a pixie bam for some time what we don’t know from these data is how what’s the minimum length of time you can be on a picks of em before you have the cardia

Version that’s the qualifier i think in this are you going to be doing follow-up studies to try and see what that the answer to that question the great question the event rate is so low that we’d have to have like an 18,000 or 20,000 patients study to find the answer to this and i don’t think that’s feasible instead we’ll probably be looking at the studies that

Have taken some of these new agents and find out what the event rate is after the study drug is used i think that’s the way we’re gonna do it and that’ll work its way into the guidelines i’m hopeful yeah so in terms of the bottom line message it’s one of optimism at this point i mean that’s congratulations because i really do think this is the important information

I think it’s consistent with the other aristotle information it looks like this is a better anticoagulant than warfarin in so many aspects and here we’ve got another indication for it with a cardioversion is pretty common in atrial fib patients and it looks like it’s effective in that situation well the paper again is in the march 25th issue of jack and this is an

Analysis from the aristotle trial please make sure you look up dr. fakers paper and a variety of other things that we’re talking about here for cardio source world news i’m executive editor rick mcguire

Transcribed from video
Apixaban in Patients Requiring Cardioversion: Insights from ARISTOTLE By CSWNews