"An experimental drug apixaban Eliquis appears better than the old standby warfarin in preventing strokes in people with the abnormal heart rhythm called atrial fibrillation a new study finds.  Over . million Americans are affected by atrial fibrillation and many take warfarin also known as Coumadin to prevent dangerous clots that can cause a stroke. Warfarin is notoriously tricky to modulate however and needs to be closely monitored  usually through monthly doctors visits. If the drugs activity isnt checked regularly it can trigger severe bleeding episodes the most serious of which can happen in the brain. Warfarin is laborintensive to manage said study researcher Dr. Jack Ansell chairman of the department of medicine at Lenox Hill Hospital in New York City. Sometimes it impairs the patients quality of life and the outcomes are very dependent on how well the drug dosing is managed he added. This new drug has a lot of advantages over warfarin. With apixaban patients can use a standard dose that doesnt need monitoring and adjusting Ansell said. Also unlike warfarin apixaban has few interactions with other drugs or foods he added. The study was funded by BristolMyers Squibb and Pfizer the makers of apixaban. Apixaban is a socalled Xa inhibitor a class of anticoagulants anticlotting drugs that work by blocking factor X a protein involved in blood clotting. Ansell expects drugs in this class will have a major effect on how atrial fibrillation is managed in the future. Another similar drug Pradaxa dabigatran has been on the market for about a year and many patients with atrial fibrillation have been switched or started on it he said.  Once apixaban is available it is going to be very difficult to avoid offering this drug to patients he said. The issue of cost remains a factor however. While generic warfarin is just pennies a dose any new brandname drug is likely to be much more expensive. According to Laura Hortas a spokeswoman for BristolMyers Squibb because apixaban is still an experimental drug its price tag remains uncertain. The new report was published online Aug.  in the New England Journal of Medicine to coincide with its presentation at the European Society of Cardiology Congress in Paris.  For the trial more than  patients with atrial fibrillation and a heightened risk for stroke were randomly assigned to receive either apixaban or warfarin.  Over an average of . years of followup there were fewer strokes or clots among patients taking apixaban . percent a year compared with patients taking warfarin . percent per year the researchers found.  This means that apixaban prevented six patients from having a stroke  patients from having a major bleeding event and eight patients from dying the researchers said in a Duke University news release.  The major effect on stroke was preventing hemorrhagic stroke which is caused by bleeding in the brain and is the most serious type of stroke. According to the researchers apixaban reduced this risk by  percent preventing four patients from having this type of stroke and two patients from having an ischemic stroke cause by a vessel blockage or stroke of uncertain origin. As to apixabans expected higher price tag Ansell said that since the drug does not require monitoring and the incidence of stroke and major bleeding are less savings in doctors visits and stroke treatment should more than compensate.  The new trial comes on the heels of another study on apixaban that was stopped early due to safety concerns. In that trial published in July in the New England Journal of Medicine apixabans use was associated with raised odds for bleeding  without providing patients with any reduction in heart attack risk.  However in that case apixaban was given to patients with coronary artery disease who were also taking two other blood thinners Ansell noted. The three of them together showed that the risk of bleeding was just too high and there was no real benefit in that population. But thats an entirely different problem compared with atrial fibrillation he said. Commenting on the latest study Dr. Gregg C. Fonarow a professor of cardiology at the University of California Los Angeles agreed that atrial fibrillation substantially increases the risk of stroke and death.  Warfarin reduces the risk of stroke in patients with atrial fibrillation but it also boosts the odds of bleeding and is often difficult to manage he said.  Apixaban is now the first oral anticoagulant blood thinner to show a statistically significant improvement in survival over warfarin in atrial fibrillation patients Fonarow said. This represents a very important therapeutic advance in the care of patients with atrial fibrillation.  More information For more information on atrial fibrillation visit the U.S. National Heart Lung and Blood Institute http_what.html. SOURCES Jack Ansell M.D. chairman department of medicine Lenox Hill Hospital New York City Gregg C. Fonarow M.D. professor cardiology University of California Los Angeles Laura Hortas spokeswoman BristolMyers Squibb Duke University news release Aug.   Aug.   New England Journal of Medicine online"