The findings of a recent worldwide trial show that the new anticoagulant drug apixaban was 21 percent more effective at preventing strokes in patients with atrial fibrilliation than warfarin (Coumadin), the current standard of care. The study, presented at the European Society of Cardiology in Paris and published in the New England Journal of Medicine, spanned nearly two years and included over 18,000 participants. Marketed under the name Eliquis by Bristol-Myers Sqibb and Pfizer, the drug also decreased episodes of major bleeding by 31 percent and reduced mortality by 11 percent, when compared to warfarin.
Eliquis does have some disadvantages, however, including its higher cost ($8 a day compared to $1 or less for warfarin), its propensity to wear off more quickly, the need to take it twice daily, and the lack of a fast-acting antidote. Despite these drawbacks, though, Dr. Christopher B. Granger, the study's lead author and a professor of medicine at Duke University, is optimistic about the therapeutic potential of the new drug: I think this is a profound trial result that will have a major impact on the practice and management of patients with atrial fibrilliation, he said. Such patients number 2.6 million in the U.S., and that number is expected to grow to 12 million by 2020, according to the Centers for Disease Control and Prevention, due to the aging of the population.
ACSH's Dr. Gilbert Ross emphasizes the importance of using drugs to prevent blood clots in patients with atrial fibrillation, since these patients have a four- to six-time increased risk of stroke. Therefore," he says, "it's important that therapies such as Eliquis, which demonstrate increased efficacy, are approved. The number of patients at risk and the devastating impact of adverse effects, mainly bleeding, warrants that clinicians have adequate options for therapy.