In the article “The New Oral Anticoagulants in Clinical Practice” published in the May 2013 issue of Mayo Clinic Proceedings (2013;88(5):495-511), there is an error in the statement related to apixaban and its efficacy in preventing ischemic strokes when compared with warfarin.
On page 509, in the “Choosing an Oral Anticoagulant” section at the last line, it reads as follows: “On the other hand, in patients with a history of ischemic strokes while taking warfarin, dabigatran and apixaban may be suitable alternatives as they are the only NOAs with a lower rate of ischemic stroke than warfarin.”
However, even though the primary outcome of systemic embolism or ischemic and hemorrhagic stroke reduction of apixaban was superior when compared with warfarin, 1.27%/y in the apixaban group vs 1.60%/y in the warfarin group (hazard ratio [HR], 0.79; 95% CI, 0.66-0.95; P<.001 for noninferiority; P=.01 for superiority), this was primarily due to hemorrhagic rather than ischemic stroke reduction. The rate of hemorrhagic stroke was 0.24%/y in the apixaban group vs 0.47%/y in the warfarin group (HR, 0.51; 95% CI, 0.35-0.75; P<.001), and the rate of ischemic or uncertain type of stroke was 0.97%/y in the apixaban group and 1.05%/y in the warfarin group (HR, 0.92; 95% CI, 0.74-1.13; P=.42). Thus, apixaban did not significantly reduce the risk of ischemic stroke compared with warfarin.
Therefore, the sentence should read: “On the other hand, in patients with a history of ischemic strokes while taking warfarin, dabigatran may be a suitable alternative as it is the only NOA with a lower rate of ischemic stroke than warfarin.”
© 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.