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Secondary analysis strengthens the safety of the blood thinner

Treatment with blood thinner apixaban has been associated with a lower risk of bleeding, death and hospitalization than warfarin, regardless of the history of stroke or previous blood clot, according to a secondary analysis presented today as a science at the cutting edge in the American Stroke Association International Stroke Association Conference 2020. The conference, from 19 to 21 February in Los Angeles, is a worldwide meeting for researchers and clinicians dedicated to stroke science and brain health.

The AUGUSTUS study, first published in March 2019, found that treatment with apixaban without aspirin resulted in fewer bleeds and fewer deaths and hospitalizations than treatment with a vitamin K antagonist (such as warfarin) plus aspirin among patients with atrial fibrillation and acute coronary syndrome and / or percutaneous coronary intervention treated with a P2Y12 inhibitor. The present study is a secondary analysis of the efficacy and safety outcomes of these treatments.

We divided the population of the AUGUSTUS study into two groups: patients with previous stroke / transient ischemic attack / thromboembolism and those without stroke / transient ischemic attack / thromboembolism. Apixaban was safer than warfarin, causing less major bleeding and more effective, resulting in death or hospitalization in both groups. “

Maria Cecilia Bahit, M.D., principal author of the study, head of cardiology at INECO Neurociencias in Rosario, Santa Fe, Argentina

In the AUGUSTUS study – a global multicenter study – 4,614 patients with atrial fibrillation and acute coronary syndrome or those undergoing percutaneous coronary intervention (PCI) with planned treatment with a P2Y12 inhibitor were randomly assigned to receive apixaban or a vitamin antagonist. K and receive corresponding aspirin or placebo for six months. Of the 4,581 patients with information available on the previous stroke, 13.8% had had a previous ischemic / transient attack or thromboembolism.

This analysis found:

Previous stroke patients were at increased risk of ischemic stroke, bleeding, hospitalization or death compared to those without previous stroke;

Apixaban without aspirin has been associated with the lowest rate of bleeding, death or hospitalization, regardless of the history of previous strokes;

The highest bleeding rate was observed in patients who received the combination of a vitamin K antagonist plus aspirin;

The risk of bleeding was greater with aspirin than with placebo among patients with no previous events; is

No significant differences between aspirin and placebo were observed between patients with and without previous stroke for other clinical outcomes.

“These findings reinforce the main findings of the AUGUSTUS study by assuring clinicians that even in a high-risk group of patients with previous strokes” less is more. “In other words, an apixaban strategy plus a P2Y12 inhibitor without aspirin has the results more favorable and triple therapy – a vitamin K antagonist plus an aspirin plus a P2Y12 inhibitor – should be avoided, “said Bahit.


American Heart Association


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