Rivaroxaban and stroke prevention in patients with atrial fibrillation: new evidence

Abstract

In the majority of patients with non-valvular atrial fibrillation (AF) anticoagulation is required to reduce the risk of stroke. Although vitamin K antagonists effectively reduce the risk of stroke, they have many disadvantages that limit their use. Rivaroxaban is a new once-daily oral anticoagulant that overcomes some of these limitations (i.e., no monitoring of anticoagulant effect required and fixed doses can be prescribed). In recent AF studies, rivaroxaban was reported to be at least as effective as warfarin for the prevention of stroke or systemic embolism but with a lesser risk of fatal bleeding and intracranial hemorrhage. More recent data have confirmed the beneficial effects of rivaroxaban, as originally described, and irrespective of the history of previous stroke, heart failure, myocardial infarction, diabetes, moderate renal dysfunction or age. In the present review the authors discuss current evidence regarding the efficacy and safety of rivaroxaban in patients with non-valvular AF.

Keywords::

• anticoagulation
• antithrombotic therapy
• atrial fibrillation
• bleeding
• hemorrhage
• rivaroxaban
• ROCKET-AF
• stroke

Financial & competing interests disclosure

This study was funded by Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance was provided by Content Ed Net.

Key issues

• In daily clinical practice, anticoagulation is required in the majority of patients with non-valvular atrial fibrillation to reduce the risk of stroke.

• Although vitamin K antagonists effectively reduce the risk of stroke, they have many disadvantages that limit their use.

• Rivaroxaban is a new oral anticoagulant, with a wide therapeutic window and a predictable anticoagulant effect. No food interactions have been described and interactions with other drugs are scarce. No monitoring of its anticoagulant effect is required and fixed doses can be given.

• Rivaroxaban is the only new oral anticoagulant currently marketed and administered once daily, which may improve medication adherence.

• The Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial showed in patients with non-valvular AF that rivaroxaban was at least as effective as warfarin for the prevention of stroke or systemic embolism, but with a lesser risk of fatal bleeding and intracranial hemorrhage.

• Different substudies of Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation have shown that the beneficial effects of rivaroxaban are consistent with the results of the overall study, irrespective of the history of previous stroke or transient ischemic attack, heart failure, myocardial infarction, diabetes, moderate renal dysfunction or elderly.