Newer drug beats Warfarin in heart trial

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Greenslopes Private Hospital was the biggest trial site in Australia for a large global study that found a newer blood-thinning treatment had better results for high-risk cardiac patients. 

‘AUGUSTUS’ is a randomised controlled trial designed to compare two drugs: the 2012-approved anticoagulant Apixaban versus Warfarin, which has been in medical use for over 50 years.

It involved patients who need blood-thinners as well as antiplatelet therapies to stop blood clots forming in the arteries. 

Researchers focused on patients with irregular heart rhythms not caused by a valve disorder, and/or having non-surgical treatment to treat dangerously decreased blood flow to the coronary arteries.

The atrial fibrillation patients in the trial received either Apixaban or Warfarin, as well as aspirin or matching placebo on top of their usual post-percutaneous coronary intervention (PCI) antiplatelet. 

Associate Professor David Colquhoun, a clinical cardiologist at Greenslopes, was the principal investigator. Interventional cardiologist Dr Paul Watson provided most of the patients at the Brisbane hospital. 

“Previously, when a patient had both atrial fibrillation and unstable angina, which can lead to a heart attack, we didn’t have concrete clinical evidence to back up which treatment path was most suitable,” A/Prof Colquhoun said.  

“What the ‘AUGUSTUS’ trial has done is to clearly show us that Apixaban is superior to Warfarin in terms of lower bleeding rates,” he added. 

Patients using antiplatelet therapies with or without aspirin had lower rates of major or clinically relevant non-major bleeding when also treated with Apixaban, compared to those also treated with Warfarin.

“Importantly, patients who had aspirin in addition to their usual anti-platelet suffered significantly higher rates of bleeding with no clinical benefit,” A/Prof Colquhoun said.

He hopes the study’s findings can lead to better evidence-based outcomes for patients. 

 “These findings translate very easily into our current methods and will play an important role when formulating treatment pathways for our patients in the future,” he said. 

A/Prof Colquhoun is also a board member of the National Heart Foundation of Australia, which is marking its 60th anniversary this year. 

Read more: Heart Week 2019 – Get to know your vital organ 

Read more: Emergency heart patient has landmark bypass 

Read more: Less risky treatment for heart ‘wear and tear’

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