Rivaroxaban Has Positive Risk-Benefit Profile for Non-Valvular A-Fib

Rivaroxaban given at doses of both 20mg and 15mg may have an improved bleeding risk profile compared to vitamin K antagonists.
Rivaroxaban given at doses of both 20mg and 15mg may have an improved bleeding risk profile compared to vitamin K antagonists.

The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois. MPR's staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

CHICAGO — Rivaroxaban has a better risk-benefit profile when compared with vitamin K antagonists (VKA) among patients with non-valvular atrial fibrillation over a 2-year time frame, according to an abstract presented at the Scientific Sessions of the American Heart Association, November 10 to 12, 2018. 

Researchers used records from the French nationwide claims database to follow patients with non-valvular atrial fibrillation for major cardiac events after using a stroke prevention of either rivaroxaban 20mg, rivaroxaban 15mg, or VKA. Patients were matched between cohorts for demographic characteristics and risk factors before inclusion in the study. 

Patients in the rivaroxaban 20mg arm and the matched cohort of vitamin K antagonists had a mean age of 71.3 years, 75.9% with CHA2DS2-VASc≥2, and 25.7% with a HAS-BLED≥3. Patients enrolled in the rivaroxaban 15mg arm and the matched cohort of patients receiving VKA, had a mean age of 80.4 years, 93.2% with CHA2DS2-VASc≥2, and 38.5% with HAS-BLED≥3. 

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At the end of 2 years, no difference was found between any group and the occurrence of stroke or systemic embolism, while the 2 rivaroxaban arms experienced significantly lower major bleeding and death.

When the risk of stroke, systemic embolism, and major bleeding are calculated together, the hazard ratio (HR) of both the rivaroxaban 20mg arm and the rivaroxaban 15mg arm are significantly lower than the VKA arm (HR, 0.73, 95% CI, 0.68-0.79 and HR, 0.83, 95% CI, 0.77-0.88, respectively).

The researchers concluded that both rivaroxaban 20mg and rivaroxaban 15mg have “a better risk profile with fewer major bleedings compared [with] VKAs, [and] no difference for stroke and systemic embolisms, and a better benefit-risk with fewer deaths and the 3 major events taken together.”

This study was supported by Bayer HealthCare. Please refer to reference for a complete list of authors' disclosures.

For more coverage of AHA 2018, click here.

Reference

Moore N, Fauchier L, Dureau-Pournin C, et al. Two-year benefit-risk of standard and reduced doses of rivaroxaban versus vitamin-K antagonists in non-valvular atrial fibrillation: a cohort study in the French Nationwide Claims Database. Abstract presentation at: 2018 AHA Scientific Sessions; November 10-12, 2018; Chicago, IL. Abstract Sa1080/1080.