Eliquis No Better Than Aspirin for Preventing Some Strokes in A-Fib Patients: Study

Researchers found a higher rate of brain bleeds among aspirin patients, but said the results were statistically insignificant.

For individuals who already suffered a stroke and may have irregular heartbeats, the findings of a new study suggest that the widely used blood thinner Eliquis may be no better than aspirin at preventing another stroke.

Eliquis was introduced in 2012 as part of a new class of blood thinner medications to reduce the risk of blood clots and strokes, particularly among patients with atrial fibrillation. It has been marketed as a superior alternative to aspirin or warfarin, leading it to become one of the top selling drugs in the world.

In findings published this month in the Journal of the American Medical Association (JAMA), researchers indicate that patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, actually experience roughly the same rates of recurrent strokes compared to patients who just received aspirin.

Researchers from the Columbia University Vagelos College of Physicians and Surgeons compared the blood thinner apixaban, sold under the brand name Eliquis, to aspirin among patients with cryptogenic stroke; a term used to classify strokes without an immediately apparent cause.

The researchers conducted a multi-center randomized clinical trial at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium, including 1,015 patients with cryptogenic stroke and evidence of atrial cardiopathy. Participants were given 5 mg or 2.5 mg twice per day of Eliquis or 81 mg of aspirin once daily.

According to the findings, the rate of stroke in both the Eliquis and aspirin groups was the same at 4.4% per year. Stroke occurred in 40 patients in the Eliquis group and 40 patients in the aspirin group.

However, no brain bleeds occurred among Eliquis patients while seven such incidents occurred in the aspirin group. Other major bleeds occurred in five patients in the Eliquis group and five patients in the aspirin group.

The researchers determined there were no statistical differences in stroke, risk of brain bleed, and other types of bleeds among the two groups.

“In this context, the current findings further support the relative safety of apixaban compared with aspirin in regard to intracranial hemorrhage,” they concluded. “Given the small overall number of such events in this trial, the reduction in intracranial hemorrhage with apixaban vs aspirin may reflect a chance finding.”

Researchers stopped the study early during the interim analysis since there was no significant improvement among participants taking anticoagulants.

Eliquis Health Concerns

Atrial cardiopathy is a dysfunction of the left atrium of the heart and is associated with stroke when atrial fibrillation, irregular or rapid heartbeat, isn’t diagnosed or observed. It is common practice for doctors to prescribe anticoagulants like Eliquis to prevent stroke in patients with cardiopathy, as blood thinners often help prevent strokes among patients with atrial fibrillation.

One in seven strokes is caused by atrial fibrillation, which often occurs with the formation of blood clots in the heart. Blot clots in the heart can trigger strokes by dislodging and blocking arteries.

More than 800,000 strokes occur every year in the U.S. alone, and most are caused by blood clots that block arteries in the brain.

Previous studies have linked Eliquis to a lower risk of stroke but an increased risk of uncontrollable bleeding. The blood thinner may help prevent blood clots as intended but may cause severe bleeding problems in one out of every 50 patients with atrial fibrillation, past researchers have warned.

The findings of the new study suggest doctors may need to refrain from prescribing blood thinners like Eliquis to prevent stroke in patients with suspected but unconfirmed atrial fibrillation.

The scientists plan to conduct more research to determine which patients benefit from anticoagulant therapy and which do not.