Clinical outcomes of patients with diabetes and atrial fibrillation treated with apixaban: results from the ARISTOTLE trial.


Journal Article

We compared clinical outcomes in patients with AF with and without diabetes in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial.The main efficacy endpoints were SSE and mortality; safety endpoints were major and major/clinically relevant non-major bleeding. A total of 4547/18 201 (24.9%) patients had diabetes who were younger (69 vs. 70 years), more had coronary artery disease (39 vs. 31%), and higher mean CHADS2 (2.9 vs. 1.9) and HAS-BLED scores (1.9 vs. 1.7) (all P < 0.0001) than patients without diabetes. Patients with diabetes receiving apixaban had lower rates of SSE [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.53-1.05), all-cause mortality (HR 0.83, 95% CI 0.67-1.02), cardiovascular mortality (HR 0.89, 95% CI 0.66-1.20), intra-cranial haemorrhage (HR 0.49, 95% CI 0.25-0.95), and a similar rate of myocardial infarction (HR 1.02, 95% CI 0.62-1.67) compared with warfarin. For major bleeding, a quantitative interaction was seen (P-interaction = 0.003) with a greater reduction in major bleeding in patients without diabetes even after multivariable adjustment. Other measures of bleeding showed a consistent reduction with apixaban compared with warfarin without a significant interaction based on diabetes status.Apixaban has similar benefits on reducing stroke, decreasing mortality, and causing less intra-cranial bleeding than warfarin in patients with and without diabetes.

Full Text

Duke Authors

Cited Authors

  • Ezekowitz, JA; Lewis, BS; Lopes, RD; Wojdyla, DM; McMurray, JJV; Hanna, M; Atar, D; Cecilia Bahit, M; Keltai, M; Lopez-Sendon, JL; Pais, P; Ruzyllo, W; Wallentin, L; Granger, CB; Alexander, JH

Published Date

  • April 2015

Published In

Volume / Issue

  • 1 / 2

Start / End Page

  • 86 - 94

PubMed ID

  • 27533976

Pubmed Central ID

  • 27533976

Electronic International Standard Serial Number (EISSN)

  • 2055-6845

International Standard Serial Number (ISSN)

  • 2055-6837

Digital Object Identifier (DOI)

  • 10.1093/ehjcvp/pvu024


  • eng