What is the evidence for the use of apixaban over aspirin in patients with afib?
Apixaban in Patients with Atrial Fibrillation
The AVERROES Trial. NEJM (March 2011)
Bottom Line: This randomized, double-blind trial compared apixaban with aspirin in 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable. Participants received apixaban 5 mg twice daily or aspirin (81 to 324 mg per day). The primary outcome was the occurrence of stroke or systemic embolism, and the study was terminated early because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI], 0.32 to 0.62; P<0.001). In patients with atrial fibrillation for whom vitamin K antagonist therapy was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage.
What is the evidence for symptom-triggered benzodiazepine treatment for alcohol withdrawal?
Symptom-Triggered vs Fixed-Schedule Doses of Benzodiazepine for Alcohol Withdrawal
Daeppen J-B. JAMA (May 2002)
Bottom line: This randomized, double-blind, controlled trial included 117 patients with alcohol dependence and compared a symptom-triggered group with a fixed-schedule group for alcohol withdrawal treatment. 56 patients were treated with oxazepam in response to the development of signs of alcohol withdrawal (symptom-triggered), and 61 patients were treated with oxazepam every 6 hours with additional doses as needed (fixed-schedule). Results showed that the symptom-triggered group was associated with a decrease in the quantity of medication (mean quantity administered of oxazepam was 37.5 mg vs 231.4 mg) and duration of treatment (20.0 hours vs 62.7 hours), with only one episode of seizures reported in the symptom-triggered group. There were no differences in the measures of comfort between the 2 groups. This suggests that symptom-triggered benzodiazepine treatment for alcohol withdrawal is safe, comfortable, and associated with a decrease in the quantity of medication and duration of treatment.
Trial Files Issue #2025-24