Clinical outcomes of patients with diabetes and atrial fibrillation treated with apixaban: results from the ARISTOTLE trial

Ezekowitz, J. A. et al. (2015) Clinical outcomes of patients with diabetes and atrial fibrillation treated with apixaban: results from the ARISTOTLE trial. European Heart Journal: Cardiovascular Pharmacotherapy, 1(2), pp. 86-94. (doi:10.1093/ehjcvp/pvu024) (PMID:27533976)

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Abstract

Aims: We compared clinical outcomes in patients with AF with and without diabetes in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial. Methods and results: The main efficacy endpoints were SSE and mortality; safety endpoints were major and major/clinically relevant non-major bleeding. A total of 4547/18 201 (24.9%) patients had diabetes who were younger (69 vs. 70 years), more had coronary artery disease (39 vs. 31%), and higher mean CHADS2 (2.9 vs. 1.9) and HAS-BLED scores (1.9 vs. 1.7) (all P < 0.0001) than patients without diabetes. Patients with diabetes receiving apixaban had lower rates of SSE [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.53–1.05), all-cause mortality (HR 0.83, 95% CI 0.67–1.02), cardiovascular mortality (HR 0.89, 95% CI 0.66–1.20), intra-cranial haemorrhage (HR 0.49, 95% CI 0.25–0.95), and a similar rate of myocardial infarction (HR 1.02, 95% CI 0.62–1.67) compared with warfarin. For major bleeding, a quantitative interaction was seen (P-interaction = 0.003) with a greater reduction in major bleeding in patients without diabetes even after multivariable adjustment. Other measures of bleeding showed a consistent reduction with apixaban compared with warfarin without a significant interaction based on diabetes status. Conclusion: Apixaban has similar benefits on reducing stroke, decreasing mortality, and causing less intra-cranial bleeding than warfarin in patients with and without diabetes.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Ezekowitz, J. A., Lewis, B. S., Lopes, R. D., Wojdyla, D. M., McMurray, J. J.V., Hanna, M., Atar, D., Bahit, C. M., Keltai, M., Lopez-Sendon, J. L., Pais, P., Ruzyllo, W., Wallentin, L., Granger, C. B., and Alexander, J. H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Heart Journal: Cardiovascular Pharmacotherapy
Publisher:Oxford University Press
ISSN:2055-6837
ISSN (Online):2055-6845
Published Online:20 March 2015

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