Rivaroxaban for stroke prevention in atrial fibrillation: a critical review of the ROCKET AF trial

Abstract

Oral anticoagulation is the mainstay of therapy for stroke prevention in patients with atrial fibrillation (AF). Vitamin K antagonists such as warfarin have many drawbacks that reduce their uptake, safety and effectiveness. The ROCKET AF trial compared rivaroxaban (20 mg/day; 15 mg/day in patients with creatinine clearance 30-49 ml/min) with dose-adjusted warfarin (international normalized ratio 2-3) in 14,264 patients with AF and a prior history of stroke or at least two other additional risk factors for stroke. The ROCKET AF trial demonstrated the noninferiority of rivaroxaban compared with warfarin for the prevention of stroke and systemic embolism, with a similar rate of major bleeding and a substantial reduction in intracranial hemorrhage. These results, in conjunction with its convenient once-daily dosing regimen, make rivaroxaban an attractive alternative to warfarin for stroke prevention in AF.

The use of rivaroxaban for the treatment of thrombotic complications in four dogs

“…Rivaroxaban has also been shown to reduce the rate of death, myocardial infarction, or stroke in patients with acute coronary disease and is not inferior to warfarin as an anticoagulant for these patients . Studies have also shown that its use results in a similar bleeding rate as wafarin, with a reduction in the risk of intracranial bleeding but an increase in risk of GI bleeding . Rebound hypercoagulability has been reported if the medication is abruptly stopped in human patients, and replacement with a different anticoagulant is recommended in this setting.…”

“…However, these medications are not as well known or well studied in veterinary patients. Rivaroxaban is a direct factor Xa anticoagulant newly approved in human patients for treatment or prevention of arterial or venous thrombosis . To the authors’ knowledge, there are no reported cases of the clinical use of rivaroxaban in dogs with thromboembolic disease.…”

The Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

“…In this way it emphasizes the important barrier concerning warfarin. Therefore, novel anticoagulants will be welcomed in real world practice against stroke prevention in patients with AF [17][18][19][20].…”

The Direct Oral Anticoagulants Apixaban, Rivaroxaban, and Edoxaban

“…An individual with this condition is 5 times more likely to suffer a stroke than a person who lacks this condition. 4 The chance of men and women over the age of 40 developing AF is 25%. 2 Historically, vitamin K antagonists (VKAs) such as warfarin (Coumadin) have formed the backbone of anticoagulant therapies for treatment of thromboembolic disease and cardiac arrhythmias.…”

“…Despite these advantages, many providers continue to use VKAs for long term management because they have little clinical experience with DOACs and VKAs have represented the gold standard for thromboembolic therapy for a long time. 1 VKA = vitamin K antagonist; DOAC = direct oral anticoagulant Figure adapted from (1,4) open access. F Fi ig gu ur re e 1 1. .…”