Related Experiment Video
Updated: Apr 26, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Apixaban and risk of myocardial infarction: meta-analysis of randomized controlled trials
Adrienn Tornyos1, András Vorobcsuk, Péter Kupó
1Department of Interventional Cardiology, Heart Institute, University of Pécs, 13 Ifjúság u, Pécs, 7624, Hungary.
Insights
Apixaban, a new oral factor Xa inhibitor, does not increase the risk of myocardial infarction (MI) or mortality in patients. This anticoagulant showed comparable cardiovascular safety to control groups in a meta-analysis of 12 randomized trials.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- The coagulation system plays a critical role in myocardial infarction (MI) development.
- Newer anticoagulants, including oral factor Xa inhibitors (anti-Xa) and direct thrombin inhibitors, show promise but have heterogeneous cardiovascular safety data.
- Apixaban is a novel oral anti-Xa agent requiring evaluation for its cardiovascular safety profile.
Purpose of the Study:
- To systematically evaluate the risk of MI and mortality in patients treated with apixaban.
- To assess the cardiovascular safety of apixaban compared to various control treatments.
- To analyze the pooled data from randomized controlled trials (RCTs) investigating apixaban's impact.
Main Methods:
- Systematic review and meta-analysis of prospective, randomized, controlled clinical trials (RCTs).
- Electronic databases were searched for relevant trials published between January 2000 and December 2013.
- Pooled analysis using a random-effects model to determine efficacy and safety outcomes, including MI frequency, cardiovascular mortality, overall mortality, and major bleeding.
Main Results:
- Twelve RCTs involving 54,054 patients were included.
- Apixaban treatment was not associated with an increased risk of MI (OR 0.90; 95% CI 0.77-1.05; p=0.17).
- Cardiovascular and overall mortality rates were comparable between apixaban and control groups (OR 0.88; 95% CI 0.72-1.06; p=0.18 and OR 0.89; 95% CI 0.77-1.03; p=0.11, respectively).
- A trend towards lower major bleeding risk was observed with apixaban (OR 0.84; 95% CI 0.62-1.12; p=0.23), reaching statistical significance in subgroup analysis of trials with anticoagulant controls (OR 0.66; 95% CI 0.51-0.87; p=0.003).
Conclusions:
- Apixaban treatment is not linked to an increased risk of myocardial infarction or mortality across a broad range of patients and control groups.
- Apixaban demonstrates comparable cardiovascular safety to existing treatments.
- Further investigation into bleeding risk, particularly in specific patient subgroups, may be warranted.
Abstract:
The coagulation system contributes greatly to the evolution of myocardial infarction (MI). Anticoagulation may reduce the occurrence of MI as monotherapy or with concomitant use of aspirin. Activated factor X antagonists (anti-Xa) and direct thrombin inhibitors have promising results in various indications in non-inferiority trials. However, results regarding their cardiovascular safety are heterogeneous. We systematically evaluated the risk of MI and mortality in patients receiving the new-generation oral anti-Xa agent apixaban. Electronic databases were searched to find prospective, randomized, controlled clinical trials (RCT) that evaluated the clinical impact of apixaban. Efficacy measures included frequency of MI, cardiovascular and overall mortality. Outcome parameters of RCTs were pooled with a random-effects model. Between January 2000 and December 2013, 12 RCTs comprising 54,054 patients were identified. Based on the pooled results, there was no increase in the risk of MI in patients treated with apixaban [odds ratio (OR) 0.90; 95 % confidence interval (CI) 0.77-1.05; p = 0.17] compared to different controls. Cardiovascular and overall mortality with apixaban was comparable to the control groups (OR 0.88; 95 % CI 0.72-1.06; p = 0.18, OR 0.89; 95 % CI 0.77-1.03; p = 0.11, respectively). The pooled risk of major bleeding was lower in the apixaban treated groups (OR 0.84; 95 % CI 0.62-1.12; p = 0.23) however this reached significant level only in subgroup analysis of trials with anticoagulant regimes in the control (OR 0.66; 95 % CI 0.51-0.87; p = 0.003). In a broad spectrum of patients and compared to different controls apixaban treatment was not associated with an increase in MI or mortality.
More Related Videos
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:26Atherosclerosis III: Management