Atrial fibrillation patients better off with rivaroxaban than warfarin - less monitoring required


Atrial fibrillation patients better off with rivaroxaban than warfarin - less monitoring required

Individuals with atrial fibrillation may be better off with rivaroxaban, because it is easier to administer than warfarin, which is in current standard treatment, researchers from the University of Edinburg and the University of North Carolina revealed in NEJM (New England Journal of Medicine). Atrial fibrillation affects approximately 7 million people in the USA and Europe and can lead to the formation of blood clots, considerably raising the risk of stroke.

Patients with irregular heartbeats, i.e. atrial fibrillation, have a four to six times higher risk of having a stroke compared to those with regular heartbeats. People of any age can have atrial fibrillation, however, it is more common among older individuals. About 10% of those aged 65+ years are affected.

The team set out to compare the effects of warfarin with rivaroxaban. Warfarin is the standard treatment to prevent blood clots for those with atrial fibrillation.

They found that rivaroxaban is as good as warfarin in reducing stroke risk. However, rivaroxaban does not require the close monitoring needed when taking warfarin. Warfarin can be affected by diet and other drugs, so individuals taking it have to be closely monitored - not so much the case with rivaroxaban. Rivaroxaban's dose does not need careful adjustment.

In this study, the investigators gathered data on 14,000 individuals with atrial fibrillation who also were at risk of stroke. They were randomly selected to receive either rivaroxaban or warfarin.

They found that the incidence of bleeding was fairly similar in both groups, but the risk of bleeding in the brain was over 50% lower in the rivaroxaban group 2 per 1,000) compared to those on warfarin (5 per 1,000).

Professor Keith Fox, a British Heat Foundation said:

"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 heart beats is just as effective while also easier to prescribe and take."

Manesh R. Patel, MD assistant Professor of Medicine at Duke University School of Medicine, said:

"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."

In an abstract in the NEJM, the authors concluded:

"In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group."

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Section Issues On Medicine: Cardiology