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This study looked at over 4000 patents with atrial fibrillation, kidney disease, and either acute coronary syndrome or percutaneous coronary intervention. Patients with a creatinine clearance below 30 mL/min were excluded. They found that apixaban worked better than vitamin K antagonists (warfarin) across a broad range of patients. Comment: Research continues to show that apixaban appears to be superior to warfarin in that it has fewer side-effects and prevents more thrombotic events. I am cautiously optimistic that it will ultimately prove to be superior to warfarin even in patients with a mechanical heart valve, but to my knowledge this still has not been demonstrated and remains hypothetical. Circulation . 2021 Jan 19.    (retrieved Jan, 2021). There are currently 1090 pearls in the database. While every attempt has been made to ensure accuracy, mistakes can and do occur. Use databank at your own risk. All pearls © 2024 by the Internet Medical Association. Click Here to view more medical pearls.