June 4, 2023

Dr. Ralph Brindis discusses the clinical implications of the ARISTOTLE trial, which showed that atrial fibrillation patients treated with apixaban had significantly lower rates of stroke and systemic embolism, major bleeding complication, and overall mortality, compared with patients randomized to warfarin.

Apixaban a new anticoagulant drug was significantly safer and more effective than warfarin for preventing stroke and systemic embolism in atrial fibrillation patients data from the clinical trial known as aristotle showed significant relative reductions in stroke systemic embolism major bleeding and overall mortality dr. ralph brindis past president of the american

College of cardiology discussed the study findings the apixaban study was incredibly important for decades now physicians have been looking for an alternative to warfarin we appreciate all the downsides and difficulties in the using of warfarin in terms of its drug drug interactions in terms of its risks of bleeding and the inconvenience of having blood tests so here

This truck this trial the aristotle trial was another study looking at an additional new oral anticoagulant that could replace coumadin i think that the aristotle trial is incredibly important i think it has basically put another dagger or stake in the heart of the use of warfarin in the management of atrial fibrillation to prevent stroke implications are huge here

We have a trial now well designed that it showed not only in terms of its primary endpoint that the drug is not only non inferior to warfarin for preventing stroke but actually superior and in addition as decreased bleeding in our patients compared to warfarin and incredibly even gives a signal that was statistically significant that the mortality rate in patients

On a pic sabbam is less than warfarin if i would view the study is a home run if you will in comparing a pic sabbam or another factor 10a inhibitor against warfarin there’s still a lot of challenges for our clinical community and our patients in the utilization of any of the new factor 10a inhibitors a particular concern for myself and our clinicians is the issue

Of patient adherence to these medications for example in warfarin although it has is incredibly inconvenient but we know that patient what the patient’s adherence is because we do blood tests every three weeks now you have a drug that you have to take twice a day and we don’t measure whether they’re complying with the medication in terms of any anticoagulant effect

So it will be very interesting to see if what we see in randomized clinical trials where we know the compliance is a hundred percent by pill counts could actually be reproduced in the clinical community this is an important concern for us clinicians what are the next steps for research well the next steps for research in terms of the factor tenet’s is trying to

Again to learn more about which particular patients would be best suited for which drug we now have in our armamentarium if you go in our own medicine chest we have warfarin a pic seban rivaroxaban and there’ll be other factor 10a inhibitors and it may be that for certain patients we would choose one drug over the other depending on their situations rivaroxaban for

Example is a once-a-day drug patients who have renal failure many different drug different strategies one of the exciting things down the line related to these new oral factor 10a inhibitors is the possible release or development if you will of a direct antidote to these medications actually being presented at this meeting something we do not have for example with

The bigoted ram the other oral agent that’s now on the market for local medical news network i’m heidi sleep you

Transcribed from video
Clinical Implications of Apixaban's Success By MDedge news and insights for busy physicians