Influence of polypharmacy on the effectiveness and safety of. Apixaban may be safer and more effective than rivaroxaban for treating nonvalvular atrial fibrillation, investigators wrote. Rivaroxaban versus warfarin for management of obese. Rivaroxaban versus warfarin in patients with nonvalvular atrial. Health care claims from the humana database from 52011 to 122012 were analyzed. 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. Apixaban in comparison to warfarin for stroke prevention in. Recently, new oral anticoagulants noas directly inhibiting thrombin dabigatran or factor xa rivaroxaban and apixaban demonstrated their noninferiority with respect to warfarin in reducing the thromboembolic risk. Anticoagulation therapy for nonvalvular atrial fibrillation.
Atrial fibrillation is a heart rhythm disorder that causes a rapid and irregular heartbeat. In addition, in the current study, total health care costs were not significantly different between rivaroxaban and warfarin users despite the significantly higher pharmacy costs of rivaroxaban users. The mean ages were 71, 69, and 71 years for the apixaban warfarin, dabigatran warfarin, and rivaroxaban warfarin cohort pairs, respectively. Effectiveness and safety of rivaroxaban versus warfarin in. 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. Apixaban versus warfarin in patients with atrial fibrillation. Josephs family medicine residency program, phoenix, arizona.
The aim of this subgroup analysis was to assess the safety and efficacy of rivaroxaban and warfarin in relation to patient age. Adult patients newly initiated on rivaroxaban or warfarin with. Effects of rivaroxaban versus warfarin on hospitalization. To decrease these adverse events, anticoagulation is routinely prescribed. Rivaroxabans impact on renal decline in patients with. Effectiveness and safety of dabigatran, rivaroxaban, and apixaban versus warfarin in nonvalvular atrial fibrillation j am heart assoc. In a doubleblind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban at a daily dose of 20 mg or doseadjusted warfarin. We introduced our study1 by stating that rivaroxaban was noninferior to adjusteddose. Rivaroxaban in atrial fibrillation british columbia. 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.
The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with nonvalvular atrial fibrillation. Pdf rivaroxaban versus warfarin in nonvalvular atrial fibrillation. In afib, the two upper chambers of the heart beat irregularly. The objective of the present study was to assess, among patients with nvaf, the effects of rivaroxaban versus warfarin on the number of hospitalization days and other health care resource utilization in a cohort of rivaroxaban users and matched warfarin users. Dabigatran and rivaroxaban versus warfarin in patients with. Comparative effectiveness of rivaroxaban versus warfarin or. In patients with af, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. Atrial fibrillation afib is the most common type of arrhythmia in the united states.
The aim of this study was to compare the safety and efficacy of doacs in patients with nonvalvular atrial fibrillation nvaf and weighing. In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. The jrocket af study found that rivaroxaban was noninferior to warfarin with respect to the principal safety outcome in patients with atrial fibrillation af. Realworld comparative effectiveness, safety, and health. Rivaroxaban versus warfarin in african american patients with. Apixaban, rivaroxaban, and dabigatran should be considered as. Methods and analysis warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Jul 21, 2020 anticoagulation therapy is an important method of preventing stroke in individuals with atrial fibrillation af. Rivaroxaban was also associated with a 45% reduction in the risk of stroke or systemic embolism versus warfarin, albeit the 95% cis crossed the line of unity. Clinical guidelines on af consistently recommend longterm oral warfarin to treat valvular atrial fibrillation vaf. Aug 08, 2019 warfarin has been associated with renovascular calcification and worsening renal function, whereas rivaroxaban may provide a degree of renopreservation by decreasing vascular inflammation. Martinez bk, bunz tj, eriksson d, meinecke ak, sood na, coleman ci.
Rivaroxaban versus warfarin in patients with nonvalvular. Sep 01, 2019 in this large us claims database analysis evaluating patients with nonvalvular atrial fibrillation and stage 4 or 5 chronic kidney disease or undergoing hemodialysis, rivaroxaban use was associated with a significant 32% lower risk of major bleeding compared with warfarin. We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large realworld population. If youve ever had the feeling of your heart fluttering or skipping beats, you may be suffering from atrial fibrillation afib. Arrhythmias happen when the heart beats too slowly, too quickly, or irregularly. Versus warfarin in nonvalvular atrial fibrillation,15 rely dabigatran versus warfarin in patients with atrial fibrillation,16 and aristotle apixaban versus warfarin in patients with atrial fibrillation 17, patients treated with rivaroxaban after its approval in november 2011 and with previous use of warfarin were included in the. Warfarin has been associated with renovascular calcification and worsening renal function. Rivaroxaban versus warfarin in patients with atrial fibrillation rocket af trial 1. Polypharmacy and the efficacy and safety of rivaroxaban. How is cryoballoon ablation for atrial fibrillation. Atrial fibrillation leads to increased risk of systemic embolism and stroke. Though the feeling may be quite disconcerting, having afib doesnt necessarily mean you have a serious health c. In a doubleblind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation nejm.
The heart is a muscle that has four chambers through which blood what can we help you find. In an investigatorinitiated trial funded by the brazilian ministry of health and bayer, with an openlabel, noninferiority design, 1005 patients median age, 59 years. Effectiveness and safety of direct oral anticoagulants in. Rivaroxaban versus warfarin in african american patients. Rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and severe kidney disease or undergoing hemodialysis. Pdf rivaroxaban versus warfarin in nonvalvular atrial. Effectiveness and safety of rivaroxaban versus warfarin.
Warfarin dramatically reduces the risk for ischemic stroke in nonvalvular atrial fibrillation, but its use among ambulatory patients with atrial fibrillation has not been widely studied. This study aimed to assess, among patients with nvaf, the effect of rivaroxaban versus warfarin on health care costs in a cohort of rivaroxaban users and matched warfarin users. Effectiveness and safety of rivaroxaban versus warfarin in obese nonvalvular atrial fibrillation patients. Feb 03, 2016 an investigation by the bmj has uncovered the use of a faulty device in a regulatory drug trial, potentially putting patients at unnecessary risk, deborah cohen reports doctors and scientists are calling for an independent investigation into the key trial underpinning use of rivaroxaban to prevent ischaemic stroke in nonvalvular atrial fibrillation after the bmj found that a defective point.
Atrial fibrillation is a quivering or irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heartrelated complications. Thromboembolism, bleeding and vascular death in nonvalvular. To evaluate the effectiveness and safety of rivaroxaban versus warfarin for prevention of stroke and systemic embolism sse in obese nonvalvular atrial fibrillation nvaf patients. We compared the impact of rivaroxaban and warfarin on renal outcomes in diabetic patients with nonvalvular atrial fibrillation nvaf. The best way to manage atrial fibrillation if to follow your doctors treatment plan. Aristophanes subgroup analysis steve deitelzweig1, allison keshishian 2,3, amiee kang 4. 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. Stroke prevention with novel oral anticoagulants in. Request pdf on dec 15, 2011, robert rosenstein and others published rivaroxaban versus warfarin in nonvalvular atrial fibrillation find, read and cite all the research you need on researchgate.
African americans aas and obese individuals have increased thrombotic risk. Womens health may earn commission from the links on this page, but we only feature products we believe in. Noacs versus warfarin for stroke prevention in patients with af. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus warfarin in obese patients with nonvalvular atrial fibrillation. Aug 01, 2020 a subanalysis of the rocket af trial suggested rivaroxaban s efficacy and safety compared to warfarin was similar across racial subgroups. Rivaroxaban vs warfarin in patients with atrial fibrillation. In patients with nonvalvular atrial fibrillation, the effects of rivaroxaban compared with warfarin did not differ by patient age. Adherence to rivaroxaban, dabigatran, and apixaban for stroke. 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 bottom line in atrial fibrillation af patients with an risk of stroke mean chads2 score 3. Sep 06, 2017 rivaroxaban is an oral anticoagulant approved in the us for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation nvaf. The potential benefit of 10 mg of rivaroxaban in this population requires further in.
Xarelto rivaroxaban is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation af. Rivaroxaban, an oral factor xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin. Department of defense population patient selection treatmentnaive patients with. Rivaroxaban is an oral factor xa inhibitor of great appeal because of its long halflife, oncedaily dosing, and reliable anticoagulation, obviating the need for laboratory monitoring.
Nov 18, 2014 in patients with nonvalvular atrial fibrillation, the effects of rivaroxaban compared with warfarin did not differ by patient age. Nonvalvular atrial fibrillation and previous stroke or transient. Martinez department of pharmacy practice, university of connecticut school of pharmacy, 69 north eagleville road, unit 3092, storrs, ct, usa. Effect of rivaroxaban versus warfarin on health care costs. Aug 26, 2019 objective to compare effectiveness and safety of warfarin and the direct oral anticoagulants doac dabigatran, rivaroxaban and apixaban in nonvalvular atrial fibrillation in routine care. Atrial fibrillation is a type of arrhythmia in which the electrical signals in the atria, or the two small chambers of the heart, are fired in a very fast and uncontrolled manner. Despite guideline recommendations, rivaroxaban is used in patients with nonvalvular atrial fibrillation and stage 4 or 5 chronic kidney disease and among those receiving hemodialysis. Methods from nationwide registries, we identified treatmentnaive patients initiating warfarin, dabigatran, rivaroxaban or apixaban for nonvalvular atrial fibrillation from july 20 to december 2015 in. Rivaroxaban versus warfarin in patients with atrial. Apixaban, dabigatran, and rivaroxaban versus warfarin for. In nonvalvular atrial fibrillation, effects of rivaroxaban. Is rivaroxaban safer and more effective than warfarin in. Effectiveness and safety of dabigatran, rivaroxaban, and. To figure out if you have atrial fibrillation afib, you must learn about the symptoms of it.
Rivaroxaban versus warfarin for management of obese african. Nonvitamin k anticoagulants like apixaban and rivaroxaban are becoming popular and being used more frequently nowadays. Dosage recommendations are approved for all adult patients to receive either 15 mg or 20 mg once daily depending upon renal function. Comparative effectiveness and safety of standard or. Backgroundthe use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation. Although rivaroxaban has fewer drugdrug interactions, it is affected by strong cytochrome p450 3a4 cyp3a4 inducers and inhibitors and by medications. 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 clinical practice. Methods in a doubleblind trial, the authors randomly assigned 14,264 patients with nonvalvular af who were at increased risk for stroke to receive either rivaroxaban at a daily dose of 20 mg or doseadjusted warfarin. Nonvalvular atrial fibrillation, stroke, warfarin, dabigatran, rivaroxaban background atrial fibrillation af is the most common sustained cardiac.
The perprotocol, astreated primary analysis was designed to determine whether rivaroxaban was noninferior to. This drug is currently listed as limited coverage benefit under pharmacare. Adherence to rivaroxaban, dabigatran, and apixaban for. Patients with nonvalvular atrial fibrillation nvaf often have multiple comorbidities requiring concomitant medications in addition to their oral anticoagulant oac. Patel mr, mahaffey kw, garg j, et al rivaroxaban versus warfarin in nonvalvular atrial fibrillation. We sought to compare rivaroxaban and warfarin s impact on renal decline in patients with nonvalvular atrial fibrillation nvaf treated in routine practice. Although rivaroxaban has demonstrated consistent drug levels in. As atrial fibrillation is a heart issue, the main cause of it is heart diseases, which include coronary artery disease, heart birth defects, heart failure, heart valve disease, weakened heart muscle cardiomyopathy, rheumatic heart disease. Commentary in this prespecified secondary analysis of the rocket af trial, halperin and colleagues report on the comparative efficacy and safety of rivaroxaban and warfarin in patients. Dec 03, 2017 among patients with nonvalvular atrial fibrillation, rivaroxaban is noninferior to warfarin in preventing stroke and systemic thromboembolism.
Drugdrug interactions in warfarin treated patients on multiple medications are common and are associated with increased bleeding risks. Oct 18, 20 nonvalvular atrial fibrillation nvaf increases the risk of systemic thromboembolic events. There is limited evidence on the effectiveness and safety of directacting oral anticoagulants in patients with nonvalvular atrial fibrillation nvaf and advanced. In a doubleblind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban at a daily dose of 20 mg or. Rivaroxaban in atrial fibrillation rivaroxaban xarelto, a direct factor xa inhibitor, is a new oral anticoagulant indicated for the prevention of stroke and systemic embolism in atrisk patients with nonvalvular atrial fibrillation af. Elderly bleeding risk of direct oral anticoagulants in. In this setting, rivaroxaban appears to be associated with less major bleeding compared with warfarin. 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. Learn more about this condition, including causes and symptoms and how its treated. Apixaban compared against rivaroxaban for atrial fibrillation. We did not address this question, nor did we make such a claim. In taiwanese patients with endstage renal disease and nonvalvular atrial fibrillation, rivaroxaban may be associated with a similar risk of major bleeding but a lower risk of thromboembolism compared with warfarin.
Warfarin for stroke prevention in patients with nonvalvular atrial fibrillation andrea darbystewart, md, st. Given the later market entry and hence small sample size, edoxaban. There are limited data on the relative effectiveness of xarelto and warfarin in reducing the risk of stroke and systemic embolism when warfarin therapy is well controlled. Efficacy and safety of apixaban, dabigatran, rivaroxaban. 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. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation pubmed. Sep 27, 2018 rivaroxaban is an effective and safe alternative to warfarin in patients with atrial fibrillation and venous thromboembolism. Although rivaroxaban has demonstrated consistent drug levels in normal weight and obese patients, sufficient confirmation of equal clinical effectiveness and safety is currently lacking. Effectiveness and safety of apixaban, dabigatran, and. Atrial fibrillation, sometimes called afib or af, is the most common type of heart arrhythmia. Ferenchick, md, ms, facp, professor of internal medicine, michigan state university, east lansing. Comparative effectiveness of rivaroxaban versus warfarin. We tested the efficacy and safety of rivaroxaban compared with warfarin in highrisk patients with thrombotic antiphospholipid syndrome. Conclusions in nonvalvular atrial fibrillation patients with type 2 diabetes, rivaroxaban was associated with an 10% relative reduction in vascular mortality and fewer bleedingrelated.
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. Feb 26, 2021 in nonvalvular atrial fibrillation patients with type 2 diabetes, rivaroxaban was associated with an 10% relative reduction in vascular mortality and fewer bleedingrelated hospitalizations versus warfarin. Rivaroxaban once daily oral direct factor xa inhibition compared with vitamin k. Methods in a doubleblind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban at a daily dose of 20 mg or doseadjusted warfarin.
The results also highlighted a reduced incidence of gastrointestinal bleeding or intracranial hemorrhage with apixaban 12. We here compare the efficacy and safety of apixaban with those of warfarin. Influence of polypharmacy on the effectiveness and safety. Rivaroxaban, a novel option for patients with atrial. Effectiveness and safety of rivaroxaban by general. Dabigatran, rivaroxaban, or apixaban versus warfarin in.
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