Comparison of idrabiotaparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: the Borealis‐Atrial Fibrillation Study. (June 2014)

• Record Type: Journal Article
• Authors: Buller, H. R.; Halperin, J.; Hankey, G. J.; Pillion, G.; Prins, M. H.; Raskob, G. E.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 12:Number 6(2014:Jun.)
• Page Start: 824
• Page End: 830
• Publication Date: 2014-06
• Subjects: Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.12546
• Languages: English
• ISSNs: 1538-7933

Abstract

<abstract abstract-type="main" id="jth12546-abs-0001"> <title>Summary</title> <sec id="jth12546-sec-0001" sec-type="section"> <title>Background</title> <p>Idrabiotaparinux, a long‐acting inhibitor of factor Xa, was shown to be effective in the treatment of patients with venous thromboembolism.</p> </sec> <sec id="jth12546-sec-0002" sec-type="section"> <title>Objective</title> <p>To assess non‐inferiority for the efficacy of idrabiotaparinux versus warfarin in patients with atrial fibrillation (AF) at risk of stroke and systemic embolism. Bleeding was also assessed.</p> </sec> <sec id="jth12546-sec-0003" sec-type="section"> <title>Methods</title> <p>This randomized, double‐blind trial enrolled patients with electrocardiogram‐documented AF. Idrabiotaparinux was administered weekly via subcutaneous injection, and warfarin was administered daily with dose adjustment to maintain the international normalized ratio between 2.0 and 3.0. Each idrabiotaparinux injection was 3 mg for the first 7 weeks, followed by 2 mg thereafter, except in patients with a creatinine clearance of 30–50 mL min<sup>−1</sup> or aged ≥ 75 years. The patients received 1.5 mg after the first 7 weeks. The efficacy outcome was the composite of all fatal or non‐fatal strokes and systemic embolism. The safety outcome was clinically relevant bleeding (major and clinically relevant non‐major bleeding).</p> </sec> <sec id="jth12546-sec-0004" sec-type="section"> <title>Results</title> <p>The study was terminated prematurely by the sponsor for strategic/commercial, not scientific, reasons, with 39% of the planned number of patients included and an average duration of treatment of 240 days. Of the 1886 idrabiotaparinux recipients, 20 developed stroke or systemic embolism (1.5% per year), whereas this occurred in 22 of the 1887 warfarin patients (1.6% per year, hazard ratio 0.98, 95% confidence interval 0.49–1.66). The annual incidence of bleeding was 6.1% in the idrabiotaparinux and 10.0% in the warfarin group (hazard ratio 0.61, 95% confidence interval 0.46–0.81).</p> </sec> <sec id="jth12546-sec-0005" sec-type="section"> <title>Conclusion</title> <p>If anything, despite its early termination, the idrabiotaparinux regimen studied suggested a comparable efficacy to dose‐adjusted warfarin, with a lower bleeding risk.</p> </sec> </abstract>