1,6Īpixaban has also been compared with aspirin for stroke prevention in NVAF in the AVERROES study. 2Īt present there are no head-to-head trials comparing the relative efficacy and safety of apixaban, rivaroxaban and dabigatran.Īpixaban has been compared with INR-adjusted warfarin for stroke prevention in patients with NVAF and at least one additional risk factor for stroke in the key study, ARISTOTLE,* a double-blind, double-dummy, randomised controlled trial of 18,201 patients. hepatic disease associated with coagulopathy and clinically relevant bleeding risk, including severe hepatic impairmentĪs with all anticoagulants, apixaban prolongs bleeding time use with caution in people with an increased risk of haemorrhage, such as those with congenital bleeding disorders, active ulcerative GI disease and a history of haemorrhagic stroke.People with NVAF should not necessarily be excluded from anticoagulant therapy solely on the basis of a high risk of bleeding determined by HAS-BLED. Use the HAS-BLED tool to identify bleeding risk and, when possible, to correct risk factors for bleeding. Oral anticoagulation is recommended for people with NVAF and a moderate to high risk of stroke (CHADS 2 score ≥ 1), 4 or, if using the CHA 2DS 2-VASc tool, a score of ≥ 1 for men, and ≥ 2 for women. 3 (See NPS Medicinewise News: Good anticoagulant practice). 3,4 The CHADS2 or CHA2DS2-VASc scoring systems are useful tools to assess risk of a thromboembolic event. Guidelines recommend use of a scoring tool to stratify people based on stroke risk.
Determine clinical need for anticoagulation Apixaban is indicated for prevention of stroke or systemic embolism in people with NVAF and at least one additional risk factor, as described in the listing restriction, which would place them at a moderate to high risk for stroke and/or systemic embolism.
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