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Published on 15 August 2011

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Stroke prevention drug emerges as warfarin alternative

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Rivaroxaban has been found to be effective as an alternative to warfarin in the prevention of stroke in atrial fibrillation (AF) patients, according to research published in the New England Journal of Medicine.

Warfarin is known to be highly effective in preventing strokes, but it is also associated with the increased risk of bleeding and requires regular monitoring and dose adjustments.

Rivaroxaban, on the other hand, does not need to be so closely monitored, although the risk of bleeding remains.

Researchers studied 14,264 patients with a history of stroke or independent risk factors, splitting them into two groups to receive either a 20mg dose of rivaroxaban or dose-adjusted warfarin daily.

Rivaroxaban was found to be non-inferior to warfarin and showed no increase in the risk of bleeding – 1,475 (14.9%) bleeding events in the rivaroxaban group, compared to 1,449 (14.5%) in the warfarin group.

“Rivaroxaban is a direct factor Xa inhibitor that may provide more consistent and predictable anticoagulation than warfarin,” said Manesh Patel, Assistant Professor of Medicine at Duke University School of Medicine.

“Warfarin has been a standard treatment for decades, but requires a rigorous monitoring schedule to ensure therapeutic dosing levels, and is subject to the potential of food and drug interactions that present treatment obstacles for patients and doctors alike.

“The results of this large global trial have convincingly shown rivaroxaban to be an alternative to warfarin in treating patients with atrial fibrillation and, importantly, with no increase in bleeding.”

Keith Fox, Professor of Cardiology at the Centre for Cardiovascular Science University and Royal Infirmary of Edinburgh, said: “Rivaroxaban appears to be an attractive and well-tolerated clinical alternative to warfarin for patients with atrial fibrillation.”

“Atrial fibrillation is becoming increasingly prevalent and can be life-threatening if not properly managed. Stroke prevention is a key treatment goal in atrial fibrillation management

“We know that about a third of patients eligible for warfarin are not currently receiving it. This may be because they are too frail and may not be able to manage taking the drug appropriately, with the need for blood tests and dosage levels to be monitored closely.

“This study shows that an alternative drug for patients with irregular heartbeats is just as effective while also easier to prescribe and take.”

In an accompanying editorial, Gregory Zoppo from the University of Washington School of Medicine, USA, and Misha Elioasziw from the University of Calgary, Canada, wrote:

“For the management of atrial fibrillation, oral alternatives to warfarin have arrived. Their simplicity of use is attractive, and they appear to have an efficacy similar to that of warfarin, with the proviso that comparisons seem to depend on how easily the patient can be treated with warfarin.”

New England Journal of Medicine



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