Among the participants taking the 2.5-mg dose, there was a 34 percent reduced risk of cardiovascular death and a 32 percent lower risk for death from any cause. Similar reductions were not seen among people taking the 5-mg dose, however.
Xarelto also reduced the risk of blood clots forming within arteries that were held open by stents -- small mesh tubes used to widen narrowed arteries.
However, addition of the new drug did boost the odds of a common blood-thinner side effect: bleeding, including bleeds within the brain. However, this increase in risk was confined to nonfatal bleeds, not fatal bleeding, the research team reported, and the incidence of bleeding fell when patients took the smaller versus the larger dose of Xarelto.
Braunwald said risks for bleeding must always be balanced against the benefits of any anti-clotting medication. "I'd rather have a patient walk out of a hospital with a bleed than [leave through] the morgue," he said.
Another study author, Dr. C. Michael Gibson, was encouraged by the findings.
"We have not seen a mortality reduction like this in cardiology for a few decades," said Gibson, who is chief of clinical research in the Division of Cardiology at Beth Israel Deaconess Medical Center in Boston. "This is secondary prevention for people who have weathered the storm and survived."
Secondary prevention refers to staving off a future coronary event among people who have already had a first one. By contrast, primary prevention is aimed at keeping that first event from occurring.
The benefit from Xarelto was consistent across all subgroups, Gibson said. "There is more bleeding," he said, "but no excess fatal bleeding or bleeding that leads to disability. I think it will be a game-changer."
According to Gibson, one big issue with the old standby drug warfarin is that doses must often be adjusted. However, using Xarelto to manage atrial fibrillation has typically been more of a "one-
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