Stroke: previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance

in the blood supply to the brain.

Two types of stroke Ischemic Stroke :most common, making up about 83 percent of all strokes. An ischemic stroke occurs when a blood vessel becomes blocked, usually by a blood clot.
Hemorrhagic Stroke : occurs when a blood vessel in the brain bursts or breaks, causing bleeding in the brain. Hemorrhagic stroke can most often be traced to high blood pressure, but it may also be caused by an aneurysm.

Atrial fibrillation/flutter: is a heart rhythm disorder (arrhythmia). It usually involves a rapid heart rate, in which the upper heart chambers (atria) are stimulated to contract in a very disorganized and abnormal manner. Symptoms Symptoms may include: Pulse that feels rapid,racing, pounding, fluttering, or too slow Pulse that feels regular or irregular Sensation of feeling the heart beat (palpitations) Shortness of breath while lying down Confusion Dizziness, light-headedness Fainting fatigue

Causes of atrial fibrillation include: Alcohol use (especially binge drinking) Congestive heart failure Coronary artery disease (especially after a heart attack or coronary artery bypass surgery) Heart surgery HPN Medications Hyperthyroidism Pericarditis Valvular heart disease (especially mitral stenosis and mitral regurgitation)

Apixaban Prevents Stroke in Patients With Atrial Fibrillation Who Are Unsuitable for Warfarin

Apixiban:: (manufacturer's designation BMS-56224701, tradename Eliquis) is a compound being investigated as an anticoagulant. It is a direct factor Xa inhibitor. It is presently undergoing phase III trials in the prevention of venous thromboembolism, together with a number of related competing compounds, such as rivaroxaban. It is being developed in a joint venture by Pfizer and BristolMyers Squibb

The data monitoring committee of the AVERROES study, seeing overwhelming evidence of the success of apixaban in the prevention of stroke in patients with atrial fibrillation who are unsuitable for the conventional treatment of warfarin, has recommended early termination of this study. The decision came after repeated review and careful consideration of all efficacy and safety data.

The study leaders, principal investigator Dr. Stuart J. Connolly, chairman of the steering committee Dr. Salim Yusuf, and project officer Dr. John Eikelboom, have accepted this recommendation, as have the study sponsors, Bristol-Myers Squibb and Pfizer.

 Results of the study were presented by Connolly at the annual European Society of Cardiology Congress in Stockholm, Sweden, on August 31. The AVERROES study enrolled 5,600 patients with atrial fibrillation at risk for stroke who were unsuitable for therapy with a Vitamin K antagonist such as warfarin. These patients were randomized, double-blind, to receive either apixaban or the standard therapy which is Aspirin. The primary efficacy outcome of the AVERROES study was a composite of stroke or systemic embolism and the major safety outcome was major bleeding.

The data monitoring committee observed a relative risk reduction for stroke and systemic embolism of more than 50 per cent, which was highly statistically significant and which met the highly conservative monitoring boundaries of the AVERROES study. There was only a modest increase in major hemorrhage that was not statistically significant. "The results of AVERROES are truly impressive," said Connolly, a professor of medicine at the Michael G. DeGroote School of Medicine at McMaster University. "The reduction in stroke and systemic embolism is very important and the increased risk of hemorrhage is small. It appears that apixaban will be an excellent treatment for the many patients with atrial fibrillation who are unsuitable for warfarin. These findings will reduce the burden of stroke in society."