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Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation).

Publication ,  Journal Article
Flaker, G; Lopes, RD; Al-Khatib, SM; Hermosillo, AG; Hohnloser, SH; Tinga, B; Zhu, J; Mohan, P; Garcia, D; Bartunek, J; Vinereanu, D ...
Published in: J Am Coll Cardiol
March 25, 2014

OBJECTIVES: The aim of this study was to determine the risk of major clinical and thromboembolic events after cardioversion for atrial fibrillation in subjects treated with apixaban, an oral factor Xa inhibitor, compared with warfarin. BACKGROUND: In patients with atrial fibrillation, thromboembolic events may occur after cardioversion. This risk is lowered with vitamin K antagonists and dabigatran. METHODS: Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, we conducted a post-hoc analysis of patients undergoing cardioversion. RESULTS: A total of 743 cardioversions were performed in 540 patients: 265 first cardioversions in patients assigned to apixaban and 275 in those assigned to warfarin. The mean time to the first cardioversion for patients assigned to warfarin and apixaban was 243 ± 231 days and 251 ± 248 days, respectively; 75% of the cardioversions occurred by 1 year. Baseline characteristics were similar between groups. In patients undergoing cardioversion, no stroke or systemic emboli occurred in the 30-day follow-up period. Myocardial infarction occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Major bleeding occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Death occurred in 2 patients (0.5%) receiving warfarin and 2 patients receiving apixaban (0.6%). CONCLUSIONS: Major cardiovascular events after cardioversion of atrial fibrillation are rare and comparable between warfarin and apixaban. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 25, 2014

Volume

63

Issue

11

Start / End Page

1082 / 1087

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Survival Rate
  • Stroke
  • Severity of Illness Index
  • Risk Assessment
  • Pyridones
  • Pyrazoles
  • Patient Safety
 

Citation

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Chicago
ICMJE
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Flaker, G., Lopes, R. D., Al-Khatib, S. M., Hermosillo, A. G., Hohnloser, S. H., Tinga, B., … ARISTOTLE Committees and Investigators, . (2014). Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation). J Am Coll Cardiol, 63(11), 1082–1087. https://doi.org/10.1016/j.jacc.2013.09.062
Flaker, Greg, Renato D. Lopes, Sana M. Al-Khatib, Antonio G. Hermosillo, Stefan H. Hohnloser, Brian Tinga, Jun Zhu, et al. “Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation).J Am Coll Cardiol 63, no. 11 (March 25, 2014): 1082–87. https://doi.org/10.1016/j.jacc.2013.09.062.
Flaker G, Lopes RD, Al-Khatib SM, Hermosillo AG, Hohnloser SH, Tinga B, Zhu J, Mohan P, Garcia D, Bartunek J, Vinereanu D, Husted S, Harjola VP, Rosenqvist M, Alexander JH, Granger CB, ARISTOTLE Committees and Investigators. Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation). J Am Coll Cardiol. 2014 Mar 25;63(11):1082–1087.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 25, 2014

Volume

63

Issue

11

Start / End Page

1082 / 1087

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Survival Rate
  • Stroke
  • Severity of Illness Index
  • Risk Assessment
  • Pyridones
  • Pyrazoles
  • Patient Safety