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  • Background Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. Methods We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg twice daily, with placebo, in addition to standard antiplatelet therapy, in patients with a recent acute coronary syndrome and at least two additional risk factors for recurrent ischemic events. Results The trial was terminated prematurely after recruitment of 7392 patients because of an increase in major bleeding events with apixaban in the absence of a counterbalancing reduction in recurrent ischemic events. With a median follow-up of 241 days, the primary outcome of cardiovascular death, myocardial infarction, or ischemic stroke occurred in 279 of the 3705 patients (7.5%) assigned to apixaban (13.2 events per 100 patient-years) and in 293 of the 3687 patients (7.9%) assigned to placebo (14.0 events per 100 patient-years) (hazard ratio with apixaban, 0.95; 95% confidence interval [CI], 0.80 to 1.11; P = 0.51). The primary safety outcome of major bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) definition occurred in 46 of the 3673 patients (1.3%) who received at least one dose of apixaban (2.4 events per 100 patient-years) and in 18 of the 3642 patients (0.5%) who received at least one dose of placebo (0.9 events per 100 patient-years) (hazard ratio with apixaban, 2.59; 95% CI, 1.50 to 4.46; P = 0.001). A greater number of intracranial and fatal bleeding events occurred with apixaban than with placebo. Conclusions The addition of apixaban, at a dose of 5 mg twice daily, to antiplatelet therapy in high-risk patients after an acute coronary syndrome increased the number of major bleeding events without a significant reduction in recurrent ischemic events. (Funded by BristolMyers Squibb and Pfizer; APPRAISE-2 ClinicalTrials. gov number, NCT00831441.)
  • Background Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. Methods We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg twice daily, with placebo, in addition to standard antiplatelet therapy, in patients with a recent acute coronary syndrome and at least two additional risk factors for recurrent ischemic events. Results The trial was terminated prematurely after recruitment of 7392 patients because of an increase in major bleeding events with apixaban in the absence of a counterbalancing reduction in recurrent ischemic events. With a median follow-up of 241 days, the primary outcome of cardiovascular death, myocardial infarction, or ischemic stroke occurred in 279 of the 3705 patients (7.5%) assigned to apixaban (13.2 events per 100 patient-years) and in 293 of the 3687 patients (7.9%) assigned to placebo (14.0 events per 100 patient-years) (hazard ratio with apixaban, 0.95; 95% confidence interval [CI], 0.80 to 1.11; P = 0.51). The primary safety outcome of major bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) definition occurred in 46 of the 3673 patients (1.3%) who received at least one dose of apixaban (2.4 events per 100 patient-years) and in 18 of the 3642 patients (0.5%) who received at least one dose of placebo (0.9 events per 100 patient-years) (hazard ratio with apixaban, 2.59; 95% CI, 1.50 to 4.46; P = 0.001). A greater number of intracranial and fatal bleeding events occurred with apixaban than with placebo. Conclusions The addition of apixaban, at a dose of 5 mg twice daily, to antiplatelet therapy in high-risk patients after an acute coronary syndrome increased the number of major bleeding events without a significant reduction in recurrent ischemic events. (Funded by BristolMyers Squibb and Pfizer; APPRAISE-2 ClinicalTrials. gov number, NCT00831441.) (en)
Title
  • Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome
  • Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome (en)
skos:prefLabel
  • Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome
  • Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome (en)
skos:notation
  • RIV/00064203:_____/11:7107!RIV12-MZ0-00064203
http://linked.open...avai/predkladatel
http://linked.open...avai/riv/aktivita
http://linked.open...avai/riv/aktivity
  • I
http://linked.open...iv/cisloPeriodika
  • 8
http://linked.open...vai/riv/dodaniDat
http://linked.open...aciTvurceVysledku
http://linked.open.../riv/druhVysledku
http://linked.open...iv/duvernostUdaju
http://linked.open...titaPredkladatele
http://linked.open...dnocenehoVysledku
  • 186572
http://linked.open...ai/riv/idVysledku
  • RIV/00064203:_____/11:7107
http://linked.open...riv/jazykVysledku
http://linked.open.../riv/klicovaSlova
  • st-segment elevation; factor xa inhibitor; high-risk patients; acute myocardial-infarction; randomized controlled-trial; knee replacement; double-blind; aspirin; clopidogrel; warfarin (en)
http://linked.open.../riv/klicoveSlovo
http://linked.open...odStatuVydavatele
  • US - Spojené státy americké
http://linked.open...ontrolniKodProRIV
  • [C7E9D18FF58B]
http://linked.open...i/riv/nazevZdroje
  • New England Journal of Medicine
http://linked.open...in/vavai/riv/obor
http://linked.open...ichTvurcuVysledku
http://linked.open...cetTvurcuVysledku
http://linked.open...UplatneniVysledku
http://linked.open...v/svazekPeriodika
  • 365
http://linked.open...iv/tvurceVysledku
  • Alexander, J. H
  • Atar, D.
  • Bhatt, DL
  • Cools, F.
  • Cornel, J. H
  • De Caterina, R.
  • Darius, H.
  • Diaz, R.
  • Flather, M.
  • Geraldes, M.
  • Goodman, S.
  • Harrington, R. A.
  • He, Y. H.
  • Huber, K.
  • Husted, SE
  • James, S.
  • Janský, Petr
  • Keltai, M.
  • Kilaru, R.
  • Lawrence, J.
  • Leiva-Pons, J. L.
  • Liaw, D.
  • Lopes, R. D.
  • Lopez-Sendon, J.
  • Mohan, P.
  • Ogawa, H.
  • Pais, P.
  • Parkhomenko, A.
  • Ruda, M.
  • Ruzyllo, W.
  • Verheugt, F. W.
  • Vinereanu, D.
  • Wallentin, L.
  • White, H.
http://linked.open...ain/vavai/riv/wos
  • 000294205300005
issn
  • 0028-4793
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