Vascular protection with rivaroxaban in the comprehensive management of atrial fibrillation

ABSTRACT

Introduction

In addition to an increased risk of thromboembolic complications, patients with atrial fibrillation (AF) are at risk for vascular events. Consequently, complete vascular protection is warranted in these patients.

Areas covered

A narrative search was conducted on PubMed (MEDLINE), using the MeSH terms [Rivaroxaban] + [Atrial fibrillation] + [Cardiovascular] + [Vascular] + [Treatment]. Original data from clinical trials, prospective and retrospective studies, useful reviews and experimental studies, were selected.

Expert opinion

The ROCKET-AF trial showed that rivaroxaban is effective in reducing the risk of stroke, with a lower risk of fatal and intracranial bleeding compared to warfarin. Remarkably, experimental data have provided a number of pathogenic mechanisms through which rivaroxaban could provide beneficial vascular properties beyond its antithrombotic activity. Moreover, in the AF population, additional to its ability to reduce the risk of thromboembolic complications, rivaroxaban is associated with a lower risk of myocardial infarction, major adverse cardiac and limb events, and vascular mortality in patients with diabetes, also attenuating renal impairment during follow-up. These findings suggest that rivaroxaban may provide a comprehensive vascular protection in patients with AF.

KEYWORDS:

• Atrial fibrillation
• cardiovascular
• chronic kidney disease
• diabetes
• myocardial infarction
• peripheral artery disease
• rivaroxaban
• vascular

Article highlights

• Patients with AF have an increased risk of both thromboembolic and vascular complications.

• A complete vascular protection is warranted in patients with AF.

• Anticoagulation is required to reduce the risk of stroke, but it seems that not oral anticoagulants would provide the same vascular benefit.

• Experimental data have provided a number of pathogenic mechanisms through rivaroxaban could provide beneficial vascular properties beyond its antithrombotic activity.

• Different studies have shown in AF population that rivaroxaban would be associated with a lower risk of myocardial infarction, major adverse cardiac and limb events and vascular mortality in patients with diabetes, also attenuating renal impairment during the follow-up, regardless of its anticoagulant effect.

Declaration of Interest

C Escobar has received honoraria as a speaker from Astra-Zeneca, Novartis, Boehringer Ingelheim, Vifor Pharma, Rovi and Bayer.

P Diez-Villanueva has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Pfizer-BMS.

C Bonanad Lozano reports lectures honoraria from Pfizer/BMS, Novartis, Daiichi-Sankyo, AstraZeneca, Sanofi, Amgen, Ferrer, Boeringher-Ingelheim and counsulting fees from Daiichi-Sankyo, AstraZeneca, Sanofi, Amgen, Menarini, Pfizer/BMS, Boeringher-Ingelheim, Bayer, Novartis.

A Pose Reino reports consulting fees and/or lectures honoraria from Astra, Boehringer, Bayer, Pfizer, Daiichi Sankyo, Sanofi, Amgen, Novartis, Menarini y Ferrer.

M Almendro reports consulting fees and/or lectures honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Eli Lilly, GlaxoSmithKline, Daiichi-Sankyo, Rovi Pharmaceuticals, and Sanofi Aventis, and grants support from AstraZeneca.

L Facila has received honoraria for lectures from Novartis, Bayer, Boehringer-Lilly, AstraZeneca, Vifor, and for participation in advisory board from Bayer, Novartis and AstraZeneca. has received fees from Novo Nordisk, Boehringer, AstraZeneca, Bayer, Esteve, Eli Lilly.

A Valle has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Pfizer-BMS.

C Suárez has received speaker and / or advisory fees from Bayer, Pfizer / BMS, Daiichi Sankyo.

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.

Reviewer disclosures

A peer reviewer for this manuscript has received speakers honoraria from Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Pfizer, and Sanofi.

A peer reviewer has received speaking fees from Daiichi-Sankyo; consulting fees from Daiichi-Sankyo and Bayer; and grant support from BMS/Pfizer and Daiichi-Sankyo.

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Acknowledgments

Writing and editorial assistance was provided by Content Ed Net, with funding from Bayer Hispania SL.

Additional information

Funding

This paper was funded by Bayer Hispania SL.