Rivaroxaban as Effective as Warfarin in Preventing Emboli and Stroke

Rivaroxaban may be an effective alternative to warfarin in prevention of stroke and emboli in patients with atrial fibrillation, according to the ROCKET AF trial, whose results were presented at the annual American Heart Association meeting on Monday.

Roughly 14,000 patients with atrial fibrillation not related to heart valve dysfunction were randomized to receive either warfarin or oral rivaroxaban (20 mg/day), an experimental drug that targets clotting factor Xa. Patients were treated for an average of 19 months.

In the per-protocol analysis, those taking rivaroxaban had fewer strokes and emboli than those taking warfarin (1.71 vs. 2.16 events per 100 patient-years); rates of major bleeding were similar between the groups. However, in the intention-to-treat analysis, rivaroxaban did not achieve statistical superiority over warfarin in the rate of strokes and blood clots; intracranial bleeding was more common with warfarin.