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Efficacy and Safety of Apixaban Versus Warfarin in Patients with Atrial Fibrillation and a History of Cancer: Insights from the ARISTOTLE Trial.
- Source :
-
The American journal of medicine [Am J Med] 2017 Dec; Vol. 130 (12), pp. 1440-1448.e1. Date of Electronic Publication: 2017 Jul 21. - Publication Year :
- 2017
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Abstract
- Background: Cancer is associated with a prothrombotic state and increases the risk of thrombotic events in patients with atrial fibrillation. We described the clinical characteristics and outcomes and assessed the safety and efficacy of apixaban versus warfarin in patients with atrial fibrillation and cancer in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.<br />Methods: The association between cancer and clinical outcomes was assessed using Cox regression models. At baseline, 1236 patients (6.8%) had a history of cancer; 12.7% had active cancer, and 87.3% had remote cancer.<br />Results: There were no significant associations between history of cancer and stroke/systemic embolism, major bleeding, or death. The effect of apixaban versus warfarin for the prevention of stroke/systemic embolism was consistent among patients with a history of cancer (event/100 patient-years = 1.4 vs 1.2; hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.53-2.26) and no cancer (1.3 vs 1.6; HR, 0.77; 95% CI, 0.64-0.93) (P interaction = .37). The safety and efficacy of apixaban versus warfarin were preserved among patients with and without active cancer. Apixaban was associated with a greater benefit for the composite of stroke/systemic embolism, myocardial infarction, and death in active cancer (HR, 0.30; 95% CI, 0.11-0.83) versus without cancer (HR, 0.86; 95% CI, 0.78-0.95), but not in remote cancer (HR, 1.46; 95% CI, 1.01-2.10) (interaction P = .0028).<br />Conclusions: Cancer was not associated with a higher risk of stroke. The superior efficacy and safety of apixaban versus warfarin were consistent in patients with and without cancer. Our positive findings regarding apixaban use in patients with atrial fibrillation and cancer are exploratory and promising, but warrant further evaluation.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Atrial Fibrillation complications
Female
Humans
Male
Middle Aged
Neoplasms complications
Stroke etiology
Thromboembolism etiology
Treatment Outcome
Anticoagulants therapeutic use
Factor Xa Inhibitors therapeutic use
Pyrazoles therapeutic use
Pyridones therapeutic use
Stroke prevention & control
Thromboembolism prevention & control
Warfarin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1555-7162
- Volume :
- 130
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The American journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 28739198
- Full Text :
- https://doi.org/10.1016/j.amjmed.2017.06.026