Rivaroxaban in patients with atrial fibrillation: from ROCKET AF to everyday practice

ABSTRACT

Introduction: Registries and non-interventional studies offer relevant and complementary information to clinical trials, since they have a high external validity.

Areas covered: The information regarding the efficacy and safety of rivaroxaban compared with warfarin, or rivaroxaban alone in clinical practice was reviewed in this manuscript. For this purpose, a search on MEDLINE and EMBASE databases was performed. The MEDLINE and EMBASE search included both medical subject headings (MeSH) and keywords including: atrial fibrillation (AF) OR warfarin OR clinical practice OR ROCKET AF AND rivaroxaban. Case reports were not considered.

Expert commentary: In ROCKET AF, rivaroxaban was at least as effective as warfarin for the prevention of stroke in patients with nonvalvular AF at high risk of stroke, but, importantly, with a lesser risk of intracranial, critical and fatal bleedings. A number of observational comparative and non-comparative studies, with more than 60,000 patients included treated with rivaroxaban, have analyzed the efficacy and safety of rivaroxaban in real-life patients with AF in different clinical settings. These studies have shown that in clinical practice, rates of stroke and major bleeding were consistently lower than those reported in ROCKET AF, likely due to the lower thromboembolic and bleeding risk observed in these patients.

KEYWORDS:

• Anticoagulation
• atrial fibrillation
• clinical practice
• rivaroxaban
• ROCKET AF
• vitamin K antagonists

Declaration of interest

G. Barón-Esquivias has received honoraria as an advisor from Bayer, Daiichi-Sankyo, BMSPfizer and Rovi; and honoraria as a speaker from Boehringer-Ingelheim, Bayer, Daiichi-Sankyo, BMS and Pfizer. F. Marín has received funding for research, consultancy services, and lecturing from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo. M. Sanmartín has received grant support from Bayer, has received honoraria as an advisor from Bayer, Boehringer and BMS; and honoraria as a speaker from Bayer, Boehringer, and Pfizer. 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. Writing and editorial assistance was provided by Content Ed Net, Madrid, Spain, with funding from Bayer Hispania.

Additional information

Funding

This paper was not funded.