Use of apixaban for prevention of a secondary brain stroke in patients with atrial fibrillation


DOI: https://dx.doi.org/10.18565/therapy.2024.7.96-104

Kasimova A.R., Tufanova O.S.

1) Academician I.P. Pavlov First Saint Petersburg State University of the Ministry of Healthcare of Russia; 2) R.R. Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Healthcare of Russia, Saint Petersburg
Abstract. Considering the necessity for secondary brain stroke prevention in patients with atrial fibrillation, it is important to comparatively evaluate the efficacy and safety of various oral anticoagulants used for this purpose.
The aim: to compare the clinical efficacy and safety of the main strategies used for secondary prevention of ischemic brain stroke based on published data from real clinical practice.
Material and methods. PubMed (MEDLINE), Scopus, and eLibrary data bases were searched using key words that included drug names or generic names of anticoagulant drugs and words describing indications for their use for secondary prevention in stroke patients.
Results and conclusion. During initial literature search 12,992 results from Pubmed, Scopus, and eLibrary were obtained. Eighteen studies were included in the systematic review. In most studies comparing apixaban with warfarin, warfarin was associated with a lower risk of stroke and systemic embolic complications, as well as major bleeding, especially intracranial hemorrhage and gastrointestinal bleeding. Apixaban is associated with little difference in the incidence of stroke and any thromboembolic events in real-world clinical practice compared with other direct oral anticoagulants and warfarin. Analyzed research works demonstrated a better safety profile for apixaban comparatively with warfarin, dabigatran etexilate, or rivaroxaban.
Keywords: brain stroke, apixaban, dabigatran etexilate, thromboembolism, prevention, atrial fibrillation
Read entire article

Literature

1. Greco A., Occhipinti G., Giacoppo D. et al. Antithrombotic therapy for primary and secondary prevention of ischemic stroke: JACC state-of-the-art review. J Am Coll Cardiol. 2023; 82(15): 1538–57.


https://doi.org/10.1016/j.jacc.2023.07.025. PMID: 37793752.


2. Gladstone D.J., Lindsay M.P., Douketis J. et al. Canadian stroke best practice recommendations: Secondary prevention of stroke update 2020. Can J Neurol Sci. 2022; 49(3): 315–37.


https://doi.org/10.1017/cjn.2021.127. PMID: 34140063.


3. Rothwell P.M., Giles M.F., Chandratheva A. et al.; Early use of Existing Preventive Strategies for Stroke (EXPRESS) study. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): A prospective population-based sequential comparison. Lancet. 2007; 370(9596): 1432–42.


https://doi.org/10.1016/s0140-6736(07)61448-2. PMID: 17928046.


4. Lioutas V.-A., Ivan C.S., Himaliet J.J. et al. Incidence of transient ischemic attack and association with long-term risk of stroke. JAMA. 2021; 325(4): 373–81.


https://doi.org/10.1001/jama.2020.25071. PMID: 33496774. PMCID: PMC7838926.


5. Клинические рекомендации. Ишемический инсульт и транзиторная ишемическая атака у взрослых. Всероссийское общество неврологов, Национальная ассоциация по борьбе с инсультом, Ассоциация нейрохирургов России, межрегиональная общественная организация «Объединение нейроанестезиологов и нейрореаниматологов», общероссийская общественная организация «Союз реабилитологов России». Рубрикатор клинических рекомендаций Минздрава России. 2021. ID: 171. Доступ:


https://cr.minzdrav.gov.ru/recomend/171_2 (дата обращения – 12.09.2024). (Clinical guidelines. Ischemic stroke and transient ischemic attack in adults. All-Russian Society of Neurologists, National Stroke Association, Association of Neurosurgeons of Russia, Association of Neuroanesthesiologists and Neuroresuscitators, Union of Rehabilitologists of Russia. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2021. ID: 171. URL: https://cr.minzdrav.gov.ru/recomend/171_2 (date of access – 12.09.2024) (In Russ.)).


6. Escudero-Martínez I., Morales-Caba L., Segura T. Atrial fibrillation and stroke: A review and new insights. Trends Cardiovasc Med. 2023; 33(1): 23–29.


https://doi.org/10.1016/j.tcm.2021.12.001. PMID: 34890796.


7. Migdady I., Russman A., Buletko A.B. Atrial fibrillation and ischemic stroke: A clinical review. Semin Neurol. 2021; 41(4): 348–64.


https://doi.org/10.1055/s-0041-1726332. PMID: 33851396.


8. Choi S.E., Sagris D., Hill A. et al. Atrial fibrillation and stroke. Expert Rev Cardiovasc Ther. 2023; 21(1): 35–56.


https://doi.org/10.1080/14779072.2023.2160319. PMID: 36537565.


9. Matos-Ribeiro J., Castro-Chaves P., Oliveira-Ferreira M. et al. Early anticoagulation in atrial fibrillation-related acute ischaemic stroke: Efficacy and safety profile. J Neurol. 2022; 269(4): 2099–2112.


https://doi.org/10.1007/s00415-021-10788-z. PMID: 34499205.


10. Барбараш О.Л., Кашталап В.В. Антикоагулянтная терапия у пациентов с неклапанной фибрилляцией предсердий: эффекты апиксабана. Доктор.Ру. 2016; (11): 10–16. (Barbarash O.L., Kashtalap V.V. Anticoagulation therapy in patients with non-valvular atrial fibrillation: Effects of apixaban. Doctor.ru. 2016; (11): 10–16 (In Russ.)). EDN: XDMSJT.


11. Byon W., Garonzik S., Boyd R.A., Frost C.E. Apixaban: A clinical pharmacokinetic and pharmacodynamic review. Clin Pharmacokinet. 2019; 58(10): 1265–79.


https://doi.org/10.1007/s40262-019-00775-z. PMID: 31089975. PMCID: PMC6769096.


12. Ammar H., Govindu R.R. A Dangerous and unrecognized interaction of apixaban. Cureus. 2021; 13(11): e19688.


https://doi.org/10.7759/cureus.19688. PMID: 34934565. PMCID: PMC8683972.


13. Guo Z., Ding X., Ye Z. et al. Non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage: A systematic review and meta-analysis of observational studies. Clin Cardiol. 2021; 44(7): 917–24.


https://doi.org/10.1002/clc.23647. PMID: 34013988. PMCID: PMC8259149.


14. Easton J.D., Lopes R.D., Bahit M.C. et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: A subgroup analysis of the ARISTOTLE trial. Lancet Neurol. 2012; 11(6): 503–11.


https://doi.org/10.1016/s1474-4422(12)70092-3. PMID: 22572202.


15. Forslund T., Wettermark B., Andersen M., Hjemdahl P. Stroke and bleeding with non-vitamin K antagonist oral anticoagulant or warfarin treatment in patients with non-valvular atrial fibrillation: A population-based cohort study. Europace. 2018; 20(3): 420–28.


https://doi.org/10.1093/europace/euw416. PMID: 28177459.


16. Lee S.I., Sayers M., Lip G.Y.H., Lane D.A. Use of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients: Insights from a specialist atrial fibrillation clinic. Int J Clin Pract. 2015; 69(11): 1341–48.


https://doi.org/10.1111/ijcp.12712. PMID: 26234557.


17. Shiga T., Naganuma M., Nagao T. et al. Persistence of non-vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation: A single-center observational study. J Arrhythm. 2015; 31(6): 339–44.


https://doi.org/10.1016/j.joa.2015.04.004. PMID: 26702312. PMCID: PMC4672038.


18. Al-Khalili F., Lindström C., Benson L. The safety and persistence of non-vitamin-K-antagonist oral anticoagulants in atrial fibrillation patients treated in a well structured atrial fibrillation clinic. Curr Med Res Opin. 2016; 32(4): 779–85.


https://doi.org/10.1185/03007995.2016.1142432. PMID: 26765366.


19. Coleman C.I., Antz M., Bowrin K. et al. Real-world evidence of stroke prevention in patients with nonvalvular atrial fibrillation in the United States: The REVISIT-US study. Curr Med Res Opin. 2016; 32(12): 2047–53.


https://doi.org/10.1080/03007995.2016.1237937. PMID: 27633045.


20. Larsen T.B., Skjøth F., Nielsen P.B. et al. Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: Propensity weighted nationwide cohort study. BMJ). 2016; 353: i3189.


https://doi.org/10.1136/bmj.i3189. PMID: 27312796. PMCID: PMC4910696.


21. Lip G.Y.H., Keshishian A., Kamble S. et al. Real-world comparison of major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin. A propensity score matched analysis. Thromb Haemost. 2016; 116(5): 975–86.


https://doi.org/10.1160/th16-05-0403. PMID: 27538358.


22. Noseworthy P.A., Yao X., Abraham N.S. et al. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation. Chest. 2016; 150(6): 1302–12.


https://doi.org/10.1016/j.chest.2016.07.013. PMID: 27938741.


23. Staerk L., Fosbøl E.L., Lip G.Y.H. et al. Ischaemic and haemorrhagic stroke associated with non-vitamin K antagonist oral anticoagulants and warfarin use in patients with atrial fibrillation: A nationwide cohort study. Eur Heart J. 2017; 38(12): 907–15.


https://doi.org/10.1093/eurheartj/ehw496. PMID: 27742807.


24. Yao X., Abraham N.S., Sangaralingham L.R. et al. Effectiveness and safety of dabigatran, rivaroxaban, and apixaban versus warfarin in nonvalvular atrial fibrillation. J Am Heart Assoc. 2016; 5(6): e003725.


https://doi.org/10.1161/jaha.116.003725. PMID: 27412905. PMCID: PMC4937291.


25. Abraham N.S., Noseworthy P.A., Yao X. et al. Gastrointestinal safety of direct oral anticoagulants: A large population-based study. Gastroenterology. 2017; 152(5): 1014–1022.e1.


https://doi.org/10.1053/j.gastro.2016.12.018. PMID: 28043907.


26. Altay S., Yıldırımtürk Ö., Çakmak H.A. et al. New oral anticoagulants-TURKey (NOAC-TURK): Multicenter cross-sectional study. Anatol J Cardiol. 2017; 17(5): 353–61.


https://doi.org/10.14744/anatoljcardiol.2016.7472. PMID: 28100898. PMCID: PMC5469081.


27. Halvorsen S., Ghanima W., Tvete I.F. et al. A nationwide registry study to compare bleeding rates in patients with atrial fibrillation being prescribed oral anticoagulants. Eur Heart J Cardiovasc Pharmacother. 2017; 3(1): 28–36.


https://doi.org/10.1093/ehjcvp/pvw031. PMID: 27680880. PMCID: PMC5216196.


28. Lamberts M., Staerk L., Olesen J.B. et al. Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients. J Am Heart Assoc. 2017; 6(2): e004517.


https://doi.org/10.1161/jaha.116.004517. PMID: 28196815. PMCID: PMC5523754.


29. Li X.S., Deitelzweig S., Keshishian A. et al. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in “real-world” clinical practice. A propensity-matched analysis of 76,940 patients. Thromb Haemost. 2017; 117(6): 1072–82.


https://doi.org/10.1160/th17-01-0068. PMID: 28300870. PMCID: PMC6291856.


30. Nielsen P.B., Skjøth F., Søgaard M. et al. Effectiveness and safety of reduced dose non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: Propensity weighted nationwide cohort study. BMJ. 2017; 356: j510.


https://doi.org/10.1136/bmj.j510. PMID: 28188243. PMCID: PMC5421446.


31. Туров А.Н., Панфилов С.В., Чиглинцева О.В. Эффективность, безопасность и приверженность при использовании новых антикоагулянтов у пациентов с фибрилляцией предсердий старше 75 лет. Рациональная фармакотерапия в кардиологии. 2020; 16(1): 10–18. (Turov A.N., Panfilov S.V., Chiglintseva O.V. The efficacy, safety and adherence to treatment when new anticoagulants taking in over 75 years old patients with atrial fibrillation. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2020; 16(1): 10–18 (In Russ.)).


https://doi.org/10.20996/1819-6446-2020-20-07. EDN: HYGKCR.


32. Рамазанова К.Г., Абдулапбазова М.Г., Джаватова Н.Н. Сравнительная эффективность ривароксабана и апиксабана в лечении и профилактике инсульта и тромбоэмболии. International Journal of Medicine and Psychology. 2024; 7(1): 9–15. (Ramazanova K.G., Abdulapbazova M.G., Dzhavatova N.N. Comparative efficacy of rivaroxaban and apixaban in the treatment and prevention of stroke and thromboembolism. International Journal of Medicine and Psychology. 2024; 7(1): 9–15 (In Russ.)).


https://doi.org/10.58224/2658-3313-2024-7-1-9-15. EDN: HHMVTW.


33. Lau W.C.Y., Torre C.O., Man K.K.C. et al. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: A multinational population-based cohort study. Ann Intern Med. 2022; 175(11): 1515–24.


https://doi.org/10.7326/m22-0511. PMID: 36315950.


34. Joglar J.A., Chung M.K., Armbruster A.L. et al.; Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149(1): e1–e156.


https://doi.org/10.1161/cir.0000000000001193. PMID: 38033089. PMCID: PMC11095842.


35. Mamas M.A., Batson S., Pollock K.G. et al. Meta-analysis comparing apixaban versus rivaroxaban for management of patients with nonvalvular atrial fibrillation. Am J Cardiol. 2022; 166: 58–64.


https://doi.org/10.1016/j.amjcard.2021.11.021. PMID: 34949473.


36. Talmor-Barkan Y., Yacovzada N.-S., Rossman H. et al. Head-to-head efficacy and safety of rivaroxaban, apixaban, and dabigatran in an observational nationwide targeted trial. Eur Heart J Cardiovasc Pharmacother. 2022; 9(1): 26–37.


https://doi.org/10.1093/ehjcvp/pvac063. PMID: 36341531.


37. Lopes R.D., Alexander J.H., Al-Khatib S.M. et al.; ARISTOTLE Investigators. Apixaban for reduction in stroke and other ThromboemboLic events in atrial fibrillation (ARISTOTLE) trial: Design and rationale. Am Heart J. 2010; 159(3): 331–39.


https://doi.org/10.1016/j.ahj.2009.07.035. PMID: 20211292.


About the Autors

Alina R. Kasimova, MD, PhD (Medicine), associate professor of the Department of clinical pharmacology and evidence-based medicine, Academician I.P. Pavlov First Saint Petersburg State University of the Ministry of Healthcare of Russia, physician – clinical pharmacologist of the Department of clinical pharmacology, R.R. Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6/8 Lva Tolstogo St.
E-mail: kasi-alina@yandex.ru
ORCID: https://orcid.org/0000-0001-6284-7133
Olga S. Tufanova, MD, physician – clinical pharmacologist of the the Department of clinical pharmacology, R.R. Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Healthcare of Russia. Address: 195427, Saint Petersburg, 8 Baykova St.
E-mail: katieva@mail.ru
ORCID: https://orcid.org/0000-0003-4891-4963


Similar Articles

Back to Content

Бионика Медиа