Q: Which of the following is found to be superior in preventing stroke or systemic embolism, lowers overall mortality and less major bleeding in comparison to warfarin, in a patient with atrial fibrillation?
A) Dabigatran
B) Rivaroxaban
C) Apixaban
D) Edoxaban
E) Asipirin
Answer: C
Out of all of the above, in a large trial of 18,000 patients (the ARISTOTLE trial), Apixaban was found to be superior in preventing stroke or systemic embolism, less major bleeding, and lowers overall mortality, when compared to dose adjusted warfarin.
Dabigatran, Rivaroxaban and Edoxaban when compared to warfarin were all found to be non-superior/inferior in their respective trials.
Aspirin is not an anticoagulation suggested for atrial fibrillation.
#cardiology
#pharmacology
References:
1. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361:1139.
2. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365:883.
3. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365:981.
4. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013; 369:2093.
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