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Rivaroxaban superior to warfarin for stroke protection in real-world nonvalvular AF population
In an observational study of real-world patients with nonvalvular atrial fibrillation, those treated with rivaroxaban had a significant risk reduction for severe stroke and all-cause mortality after stroke compared with patients who were prescribed warfarin, according to research published in Stroke.
In a retrospective cohort study of patients who began treatment with rivaroxaban (Xarelto, Janssen/Bayer) or warfarin within 30 days of nonvalvular AF diagnosis, researchers found that rivaroxaban reduced the risk for stroke by 19% (HR = 0.81; 95% CI, 0.73-0.91) compared with warfarin.
Moreover, analysis by stroke severity found that rivaroxaban provided a 48% risk reduction for severe stroke (NIH stroke scale score, 16 to 42; HR = 0.52; 95% CI, 0.33-0.82) and 19% for minor stroke (NIH stroke scale score, 1 to < 5; HR = 0.81; 95% CI, 0.68-0.96) compared with warfarin, but revealed no difference for moderate stroke (NIH stroke scale score, 5 to < 16; HR = 0.93; 95% CI, 0.78-1.1).
“This study showed risk reduction with rivaroxaban treatment in stroke overall and across all but the moderate stroke category,” Mark Alberts, MD, FAHA, chief of neurology at Hartford Hospital and physician-in-chief at Ayer Neuroscience Institute, Hartford, Connecticut, and colleagues wrote. “A possible explanation for the nonsignificant risk reduction for moderate stroke is insufficient power, given that the occurrence of stroke is so rare in this study population of patients with nonvalvular AF taking anticoagulants.”
In other findings, patients with nonvalvular AF who were treated with rivaroxaban experienced a risk reduction for all-cause mortality of 24% poststroke (HR = 0.76; 95% CI, 0.61-0.95) and 59% within 30 days (HR = 0.41; 95% CI, 0.28-0.6) compared with patients treated with warfarin.
For this retrospective cohort study, researchers included de-identified patients from the Optum Clinformatics Database who received rivaroxaban or warfarin within 30 days of initial diagnosis for nonvalvular AF. Before diagnosis, patients had 6 months of continuous health plan enrollment and a CHA2DS2-VASc score of at least 2.
“This study’s findings may help health care providers choose more effective treatments for managing their patients with nonvalvular AF, which may improve stroke prevention, optimize functional outcomes secondary to risk reduction of severe stroke and reduce mortality from stroke,” the researchers wrote. – by Scott Buzby
Disclosures: This study was supported by Janssen Scientific Affairs. Alberts reports he received consultant fees in the past from Janssen Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.