A trial of more than 18,000 patients with irregular heartbeats showed apixaban is better and safer than warfarin, the drug based on rat poison that is used by half a million Britons.
The new drug cut deaths by 11 per cent, reduced strokes by one fifth and lowered the rate of internal bleeding by almost a third.
Apixaban is one of a new generation of anti-clotting agents aimed at preventing strokes and other potentially fatal events in people with atrial fibrillation (AF).
The results of the latest trial, presented at the European Society of Cardiology congress in Paris yesterday, add to pressure for a sea change in the treatment of AF, even though the new agents are more expensive than warfarin.
In AF, the upper chambers of the heart are out of rhythm and beat faster than normal, causing blood to pool and clot. It is the cause of around one in seven first-time strokes.
Warfarin, which is still used as rat poison, has been given routinely to AF patients for decades, reducing the rate of stroke by up to two-thirds, at the cost of an increased risk of bleeding.
But its benefits have now been eclipsed by the study of 18,000 patients with AF in 39 countries.
There were 11 per cent fewer deaths from any cause among those taking the new drug twice a day.
In addition, strokes were cut by 21 per cent and there was a 31 per cent reduction in major bleeding, including brain haemorrhage.
Warfarin has been given to patients with atrial fibrillation for several years and reduced the risk by up to two thirds
It is the first trial involving any of three new anti-coagulants to show a ‘significant reduction’ in the risk of death from all causes among AF patients compared with warfarin.
Apixaban, also known by its brand name Eliquis, is licensed for short-term use to prevent blood clots in patients undergoing hip and knee replacements.
But makers Bristol-Myers Squibb and Pfizer do not expect it to be licensed until next year for stroke prevention in AF patients, who would have to take it for life.
The NHS rationing body, Nice, will then have to approve it for widespread use, but the increase in cost is likely to be huge as warfarin costs less than £1 a month, plus clinic visits.
Nice has already given a preliminary opinion on a rival anti-coagulant called Pradaxa, saying it is not cost-effective at £919 a month.
A spokesman for The Stroke Association said: ‘Although warfarin is effective in preventing strokes, it is often underused by GPs. One of the reasons for this is patients have to have regular blood tests to monitor the drug’s effects.’
John Camm, professor of clinical cardiology at St George’s Hospital Medical School, London, said: ‘This is going to be like taking an aspirin tablet once or twice a day, depending on the drug, without the need for monitoring.
‘It offers opportunities for more people with AF to benefit who are not prepared to take warfarin.’
Jenny Hope
29 August 2011
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