Apixaban vs. Warfarin for Atrial Fibrillation

Abstract This chapter appraises the ARISTOTLE trial, which tested whether apixaban is noninferior to warfarin in preventing stroke and systemic embolism in patients with atrial fibrillation. Researchers conducted the trial between 2006 and 2011 across 39 countries, enrolling over 18,000 participants. Apixaban significantly reduced stroke, major bleeding, and mortality, demonstrating superiority in primary outcomes. The warfarin group maintained a therapeutic international normalized ratio only 62% of the time, which may underestimate warfarin’s potential when managed optimally. Guidelines now recommend direct oral anticoagulants over warfarin for most patients. Finally, the chapter discusses apixaban’s overall clinical value, including safety profile and ease of use.