atrial fibrillation and stroke prevention - Continuing Medical ...

Essentials in Primary Care Conference
Wednesday, July 31, 2013
Apixaban Dosing in A Fib
• 5 mg twice daily
• 2.5 mg twice daily for either:
-Age > 80 yrs of age
-Body weight 60 Kg or less
-Creatinine > 1.5 mg/dl
-Dual inhibitors of cytochrome P450 3A4 and
p-glycoprotein such as ketoconazole and
clarithromycin
Warfarin Comparison Trials in Atrial Fib
TRIAL RE-LY ROCKET-AF ARISTOTLE
n =18,113 (3 arms) n=14,264 n=18,201
Drug (Brand name) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Apixiban (Eliquis)
150 mg twice a day 20 mg once daily with 5 mg twice a day
evening meal
Trial design, randomized Open label Double blind, double dummy Double blind, double dummy
Mean Age (yrs) 72 73 70
Male ratio 63.6% 60.1% 65.3%
Previous CVA 20% 55% 19%
CHADS score mean 2.1 3.5 2.1
% 0-1 32% 0% 34%
% >3 33% 87% 30%
TTR (%) median/mean ? / 64% 57.8% / 55% 66.0% / 62.2%
Efficacy % vs warfarin 1.71 vs. 1.11 p