We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large realworld population. Effectiveness and safety of dabigatran, rivaroxaban, and. Apixaban and rivaroxaban are the most commonly prescribed direct oral anticoagulants for adults with atrial fibrillation, but headtohead data comparing their safety and effectiveness are lacking. To decrease these adverse events, anticoagulation is routinely prescribed. Rivaroxaban is an oral anticoagulant approved in the us for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation nvaf. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation. Vitamin kinhibiting anticoagulants, especially warfarin, have become standard treatment for reducing the incidence of strokes and systemic emboli in patients with nonvalvular atrial fibrillation. Atrial fibrillation af is recognised as the most common sustained cardiac arrhythmia in the united states and is associated with a nearly fivefold excess of stroke 1. Comparative effectiveness and safety of standard or. As many as 1 in 10 patients with nonvalvular atrial fibrillation have concomitant moderatetosevere chronic kidney disease 1 and 810% of patients are receiving hemodialysis. Stroke prevention in nonvalvular atrial fibrillation jacc. Nov 30, 2018 dabigatran and rivaroxaban at standard or reduced doses have been compared to warfarin in nonvalvular atrial fibrillation nvaf, but not to each other.
Dabigatran and rivaroxaban at standard or reduced doses have been compared to warfarin in nonvalvular atrial fibrillation nvaf, but not to each other. Atrial fibrillation af is the most common arrhythmia and confers a substantial stroke risk, ranging from 20% in the absence of anticoagulation. Interrupting anticoagulation in patients with nonvalvular. Nonvalvular atrial fibrillation af more than quadruples the risk of stroke. Oral anticoagulation oac therapy is standard of care for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation nvaf, in whom the risk of stroke is 5fold higher than in the general population. Pdf the use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment find, read. In patients with nonvalvular atrial fibrillation, apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin. Influence of polypharmacy on the effectiveness and safety of. Rivaroxaban vs warfarin in patients with atrial fibrillation 1 rivaroxaban once daily oral direct factor xa inhibition compared with vitamin k antagonism for prevention of stroke and embolism trial in af. There was no significant betweengroup difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group. We selected nvaf patients initiating oral anticoagulant use in 20102014 enrolled in marketscan. We sought to assess the effectiveness and safety of apixaban, dabigatran and rivaroxaban versus warfarin in frail nonvalvular atrial fibrillation patients. Apixaban in comparison to warfarin for stroke prevention. Nonvitamin k anticoagulants like apixaban and rivaroxaban are becoming popular and being used more frequently nowadays.
To compare the safety and effectiveness of apixaban versus rivaroxaban for patients with nonvalvular atrial fibrillation. The growing epidemic of atrial fibrillation worldwide has raised concerns about the dire need for effective stroke prevention systems in these patients. We introduced our study1 by stating that rivaroxaban was noninferior to adjusteddose. Diagnosis and treatment of atrial fibrillation american. Rivaroxaban versus warfarin in patients with nonvalvular. In atrial fibrillation af patients with an risk of stroke mean chads2 score 3. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus warfarin in frail patients with nonvalvular atrial fibrillation. Sep 15, 2016 even with optimal compliance, patients using warfarin are within the therapeutic range 2 to 3 for nonvalvular atrial fibrillation only 55% to 66% of the time. Rivaroxabans impact on renal decline in patients with.
Rivaroxaban vs warfarin in patients with atrial fibrillation. The scope of this update of the 2014 af guideline includes revisions to the. The risk of intracranial hemorrhage is high in asian patients. Apixaban and rivaroxaban are newer blood thinners that are being recommended over warfarin because of their improved safety.
Rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and stage ivv chronic kidney disease. Three propensity score matched cohorts were created. Nonvalvular atrial fibrillation, stroke, warfarin, dabigatran, rivaroxaban background atrial fibrillation af is the most common sustained cardiac arrhythmia, with a lifetime risk of 1 in 4 in the. Comparison of dabigatran, rivaroxaban, and apixaban for. Rivaroxaban, an oral factor xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin. Using an administrative claims database we identified patients with af who were users of dabigatran, rivaroxaban, or apixaban. Atrial fibrillation af is the most common sustained cardiac arrhythmia and is associated with increased morbidity, mortality, and healthcare costs. Rivaroxaban users were matched with warfarin and dabigatran users by age, sex.
Comparative effectiveness of dabigatran and rivaroxaban. Warfarin has been associated with renovascular calcification and worsening renal function, whereas rivaroxaban may provide a degree of renopreservation by decreasing vascular inflammation. Medline and central, regulatory agencies websites, clinical trials registers and conference proceedings were searched to identify randomised controlled trials of noac versus warfarin in nvaf. This drug is currently listed as limited coverage benefit under pharmacare. The proportion of atrial fibrillationassociated strokes data from selected. Comparative effectiveness of dabigatran and rivaroxaban versus warfarin for the treatment of nonvalvular atrial fibrillation lindsay gs bengtson, phda, pamela l. Direct oral anticoagulant use in nonvalvular atrial. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation. Methods and results using us marketscan claims data from november 2011 to december 2016, we identified frail oral anticoagulant. Although trials have individually compared apixaban and rivaroxaban with warfarin in patients with atrial fibrillation.
Pdf rivaroxaban versus warfarin in nonvalvular atrial fibrillation. Comparison of oncedaily administration of edoxaban and. Claudia stollberger and josef finsterer challenge our methods and conclusions and question whether rivaroxaban is safer and more effective than warfarin in patients with atrial fibrillation and stroke or transient ischaemic attack tia. Effectiveness and safety of apixaban compared with. Fortunately, the last decade has witnessed a plethora of data on novel stroke prevention methods in patients with nonvalvular atrial.
Request pdf on dec 15, 2011, scott pearson and others published rivaroxaban versus warfarin in nonvalvular atrial fibrillat ion find, read and cite all the research you need on researchgate. Maclehose, phdb, and alvaro alonso, md, phdd ahealth economics and outcomes research, life sciences, optum, eden prairie, mn, usa bdivision of epidemiology and community health, school. Warfarin is severely underused in nonvalvular atrial fibrillation nvafpatients in china. Apixaban versus warfarin in patients with atrial fibrillation. Effectiveness and safety of apixaban, dabigatran, and. Rivaroxaban reduced stroke and systemic embolism compared.
Specifically it is used to treat deep vein thrombosis and pulmonary emboli and prevent blood clots in atrial fibrillation and following hip or knee surgery. Dabigatran versus warfarin in patients with atrial fibrillation. Using a large us administrative claims database, we created three onetoone propensityscorematched cohorts of patients with nonvalvular af who were users of dabigatran, rivaroxaban, or apixaban between october 1, 2010 and february 28, 2015. This was a new user study of standard dose and reduced dose dabigatran or rivaroxaban for nvaf in the french healthcare database, matched on gender, age, date of first dispensing, and high. Comparative effectiveness of dabigatran versus warfarin in. We evaluated the safety and effectiveness of oral factor xa inhibitors versus warfarin in nonvalvular atrial fibrillation patients at highrisk for falls.
Direct comparison of dabigatran, rivaroxaban, and apixaban. Oral anticoagulants vs aspirin in nonvalvular atrial. Warfarin coumadin, bristolmyers squibb and other vitamin k antagonists vkas are highly. We aimed to compare the effectiveness and safety of dabigatran, rivaroxaban, and apixaban in. Is rivaroxaban safer and more effective than warfarin in.
Rivaroxaban versus warfarin in patients with nonvalvular atrial. A randomized comparison of minidose warfarin vs adjusteddose warfarin found that the rate of ischemic stroke was significantly higher in the minidose group 3. Patients with nonvalvular atrial fibrillation nvaf often have multiple comorbidities requiring concomitant medications in addition to their oral anticoagulant oac. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation. We sought to compare rivaroxaban and warfarins impact on renal decline in patients with nonvalvular atrial fibrillation nvaf treated in routine practice. Patients and clinicians now have a choice between different noacs, but there is no direct comparative effectiveness evidence to guide decisionmaking. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation article in new england journal of medicine 36524. Stroke prevention in nonvalvular atrial fibrillation. Rivaroxaban, sold under the brand name xarelto among others, is an anticoagulant medication blood thinner used to treat and prevent blood clots. Dabigatran, rivaroxaban, or apixaban versus warfarin in patients with nonvalvular atrial fibrillation. In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment.
Backgroundthe use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose. Atrial fibrillation af is the most common cardiac arrhythmia, and its prevalence is growing worldwide. Apr 18, 2017 use of warfarin in nonvalvular atrial fibrillation rajat deo, md, remarks on the advantages and disadvantages of warfarin use in preventing stroke in patients with nonvalvular atrial fibrillation. Use of warfarin in nonvalvular atrial fibrillation rajat deo, md, remarks on the advantages and disadvantages of warfarin use in preventing stroke in patients with nonvalvular atrial fibrillation. We selected nvaf patients initiating oral anticoagulant use in 20102014 enrolled in. Comparative effectiveness of rivaroxaban versus warfarin or. Realworld comparison of major bleeding risk among nonvalvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin. Using a large us insurance database, we identified privately insured and medicare advantage patients with nonvalvular atrial fibrillation who were users of apixaban, dabigatran, rivaroxaban, or warfarin between october 1, 2010, and june 30, 2015. Pdf rivaroxaban versus warfarin in nonvalvular atrial.
The objective of this study was to evaluate the impact of polypharmacy on the effectiveness and safety of rivaroxaban versus warfarin in patients with nvaf managed in routine. The loes for warfarin, dabigatran, rivaroxaban, and apixaban have not been updated for greater. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. Ischemic stroke in patients with atrial fibrillation is associated with substantial morbidity and mortality.
Af prevalence in the united states was estimated at 5. Josephs family medicine residency program, phoenix, arizona. Rocket af showed rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism and reduced intracranial and fatal bleeding. Rocket af steering committee and investigators obs.
The introduction of nonvitamin k antagonist oral anticoagulants noacs has been a major advance for stroke prevention in atrial fibrillation af. When compared with warfarin, rivaroxaban was associated with similar risk of any bleeding, mortality, and acute. Epub ahead of print rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and stage ivv chronic kidney disease. Atrial fibrillation leads to increased risk of systemic embolism and stroke. Effectiveness and safety of apixaban versus rivaroxaban. Dabigatran, rivaroxaban, or apixaban versus warfarin in. Comparative effectiveness of rivaroxaban versus warfarin. We did not address this question, nor did we make such a claim. The 2014 american college of cardiologyamerican heart associationheart rhythm society. Major bleeding risk during anticoagulation with warfarin. Backgroundthe use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment.
Bai et al rivaroxaban vs dabigatran in atrial fibrillation 971. These data were presented as an oral abstract april 3, 2016 at the american college of cardiology scientific sessions, chicago il. We here compare the efficacy and safety of apixaban with those of warfarin. Effectiveness and safety of apixaban versus warfarin in. Review article dabigatran, rivaroxaban, or apixaban versus. Luisa suarezgea, 1 and emilio vargascastrillon 2, 3. Warfarin for stroke prevention in patients with nonvalvular atrial fibrillation andrea darbystewart, md, st.