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Apixaban is effective in preventing strokes in patients with atrial fibrillation detected by devices, finds study

A worldwide study led by Jeff Healey, a senior scientist at McMaster University and Hamilton Health Sciences, found that the common blood thinner apixaban significantly lowers the risk of stroke in people with device-detected atrial fibrillation also called sub-clinical atrial fibrillation (SCAF). This type of atrial fibrillation is only detectable by a pacemaker or other implanted cardiac electronic device and is not easily identified through standard tests like electrocardiograms.

Published in the New England Journal of Medicine (NEJM) recently, the study involved over 4,000 participants at 288 sites in 16 countries over eight years, making it the largest and longest-running study of apixaban for people with device-detected atrial fibrillation. Apixaban, an oral anticoagulant medication, reduced the risk of stroke and blood clotting by 37% and fatal or disabling stroke by 49% in individuals with SCAF.

Lead researcher Jeff Healey presented the findings at the American Heart Association Scientific Sessions, highlighting that while there was an increase in major bleeding, this non-fatal bleeding is usually reversible, and most patients recover from it. Co-principal investigator Stuart Connolly of PHRI emphasised that considering the severity and life-altering nature of the strokes prevented by apixaban compared to bleeding cases, the findings indicate that apixaban should be considered for patients with stroke risk factors who develop device-detected atrial fibrillation.

Renato Lopes, co-principal investigator of the study and a cardiologist at Duke University School of Medicine, stated that the findings can assist doctors in treating patients with device-detected atrial fibrillation to prevent disabling and fatal strokes.

The study has broader implications in the context of increasing use of implanted and wearable cardiac monitors, as well as consumer devices like the Apple Watch. The researchers anticipate a future where more at-risk individuals are identified and receive effective stroke prevention treatment.

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Indian Scenario

Speaking to Drug Today Medical Times, Dr Vinodh Kumar S, MBBS, MD (Internal Medicine), Consultant Physician and Diabetologist at Connect & Heal, said that one in four individuals will experience a stroke during their lifetime, a statistic that underscores the gravity of the issue. What is even more disconcerting is the fact that a staggering 90% of these strokes are potentially avoidable. This salient point emphasises the critical importance of addressing an array of pivotal risk factors, encompassing high blood pressure, irregular cardiac rhythm, tobacco consumption, dietary choices, and physical activity.

"In 2019, India earned the rather unfortunate distinction of recording the highest number of new stroke cases globally," he said.

Referring to a recent study published in The Lancet, conducted by the Indian Council of Medical Research in collaboration with medical institutions in India, Sri Lanka, and Singapore, Dr. Kumar said, The study underscores the magnitude of the stroke epidemic in the country. It reveals that stroke is the most substantial contributor to neurological disorder DALYs (disability-adjusted life years) in India, accounting for a staggering 37.9% of the burden."

Stressing that the gravity of this situation extends beyond India's borders, he added, "The study projects a significant global increase in stroke-related deaths, estimating that by 2050, the worldwide toll could rise to 9.7 million, with the brunt of this increase primarily affecting low- and middle-income countries."

"However, a glimmer of hope shines through an innovative study conducted in India, published in the Lancet Global Health journal," Dr. Kumar pointed out.

Explaining that This study shows how mobile health (mHealth), using mobile and wireless devices to enhance health and provide care, has the potential to prevent secondary strokes, Dr. Kumar stated, "The research conducted across 31 stroke centres in India employed a package of SMS text messages, health education videos, and stroke prevention workbooks for patients," he added.

"The results show that mHealth interventions can lead to improved lifestyle-related behaviours that have the potential to prevent secondary strokes, Dr Kumar emphasised.

Pointing out that early recognition is crucial in stroke prevention and treatment, he appealed to the use of the Face (check for drooping), Arms (observe arm drift), Speech (listen for slurred speech), and Time (F.A.S.T.) methods to call emergency services immediately at 102 or 108 if any signs are present, noting the symptom onset time.

However, he cautioned against avoiding driving to the hospital and advised letting medical professionals provide life-saving treatment en route.

Emphasising that a proper lifestyle helps in reducing heart disease risk, Dr. Kumar said, “Engaging in regular physical activity, even light exercise, positively impacts cardiovascular health.”

"However, alcohol intake elevates blood pressure and heart disease risk, while tobacco use significantly increases heart disease risk due to nicotine's impact on blood pressure and reduced oxygen flow from cigarette smoke,” he added.

Explain that recovery from stroke involves therapies like speech, physical, and occupational therapy, along with support from friends and family. Dr. Kumar said, “Rehabilitation is integral for regaining a normal quality of life based on stroke severity.”

Talking about how recent advancements in acute stroke management, such as mechanical thrombectomy and thrombolytic medication like TPA, have transformed treatment outcomes, he said, “Mechanical thrombectomy benefits patients with large vessel occlusions, while TPA within 4.5 hours of symptom onset substantially improves recovery chances.”

“Time is critical, and stroke-ready hospitals equipped with proper infrastructure are essential,” he pointed out.

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