Asundexian May Offer Safer Stroke Prevention in AF Patients New to Blood Thinners: OCEANIC-AF Analysis

The key outcomes assessed were stroke or systemic embolism for efficacy and major bleeding for safety. Data were analyzed between June and July 2024 to understand how prior anticoagulant exposure influenced the response to asundexian versus Apixaban.

The following were the key findings of the study:

• Among 14,810 participants in the OCEANIC-AF trial, 17% were OAC naive, and 83% were OAC experienced. The mean age was 72.6 years for OAC-naive and 74.2 years for OAC-experienced participants.
• In the asundexian group, stroke or systemic embolism occurred in 0.8% of OAC-naive and 1.4% of OAC-experienced patients.
• In the apixaban group, stroke or systemic embolism rates were 0.6% in OAC-naive and 0.3% in OAC-experienced patients.
• The risk increase with asundexian versus apixaban was smaller in OAC-naive (HR 1.42) than in OAC-experienced patients (HR 4.66), with a significant interaction.
• Major bleeding was lower with asundexian in both OAC-naive (0.2%) and OAC-experienced (0.2%) patients, compared to apixaban (1.0% and 0.7%, respectively).

In the OCEANIC-AF trial, asundexian was associated with a smaller increase in stroke or systemic embolism and a comparable reduction in bleeding risk among OAC-naive patients compared to apixaban, with these differences less pronounced in OAC-experienced individuals.

"While the exact mechanism remains unclear, the findings highlight the need for further investigation into how prior anticoagulant exposure may influence treatment response," the authors wrote.

Reference:

Alexander JH, Lydon EJ, Piccini JP, et al. Asundexian or Apixaban in Patients With Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial. JAMA Cardiol. Published online March 26, 2025. doi:10.1001/jamacardio.2025.0277