Novel Blood Thinner Asundexian Lowers Bleeding Risk in Atrial Fibrillation
New findings from the OCEANIC-AF trial reveal trade-offs between stroke prevention and bleeding risk in treatment-naive patients
Topline:
A new oral blood thinner, asundexian, may reduce bleeding risk in patients with atrial fibrillation who have not previously taken anticoagulants, though it shows a slightly higher rate of stroke compared to apixaban.
Study Details
The findings come from a subgroup analysis of the OCEANIC-AF trial, which included 14,810 patients across 38 countries. Researchers compared outcomes between asundexian and apixaban in patients with atrial fibrillation (AF), particularly focusing on those who were oral anticoagulant (OAC) naive (≤6 weeks of prior OAC use) and those who were OAC experienced (>6 weeks of use).
Methodology
Participants were randomly assigned to receive:
Asundexian: 50 mg once daily
Apixaban: 5 mg twice daily (or 2.5 mg for dose-reduction eligible patients)
Researchers measured two primary outcomes:
Efficacy: Rate of stroke or systemic embolism
Safety: Incidence of major bleeding
Key Findings
Among OAC-naive patients:
Stroke/systemic embolism: 0.8% (asundexian) vs 0.6% (apixaban)
Bleeding: 0.2% (asundexian) vs 1.0% (apixaban)
Among OAC-experienced patients:
Stroke/systemic embolism: 1.4% (asundexian) vs 0.3% (apixaban)
Bleeding: 0.2% (asundexian) vs 0.7% (apixaban)
Asundexian significantly reduced major bleeding risk, especially in those new to anticoagulant therapy. However, it carried a modestly increased risk of stroke in this group and a larger increase in those already on anticoagulants.
Implications for Practice
For newly diagnosed AF patients or those about to start anticoagulation, asundexian may offer a safer bleeding profile. The slight increase in stroke risk compared to apixaban appears smaller in OAC-naive individuals, suggesting this group might benefit most from asundexian—particularly when bleeding risk is a concern.
Still, apixaban remains more effective in preventing stroke. Asundexian's role may be best suited for patients where bleeding avoidance takes priority, or where apixaban is contraindicated.