Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation

Piccini, Jonathan P.; Hellkamp, Anne S.; Washam, Jeffrey B.; Becker, Richard C.; Breithardt, Günter; Berkowitz, Scott D.; Halperin, Jonathan L.; Hankey, Graeme J.; Hacke, Werner; Mahaffey, Kenneth W.; Nessel, Christopher C.; Singer, Daniel E.; Fox, Keith A.A.; Patel, Manesh R.

doi:10.1161/circulationaha.115.018544

Cited by 154 publications

(238 citation statements)

References 17 publications

(16 reference statements)

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“…There is some evidence that polytherapy may be associated with a reduced clinical benefit of AP and with increased bleeding risk in patients receiving RI [90,91].…”

Section: Conditions Associated With High Risk Of Bleedingmentioning

confidence: 99%

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Grisoglio

Brunetti

et al. 2017

European Journal of Internal Medicine

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“…There is some evidence that polytherapy may be associated with a reduced clinical benefit of AP and with increased bleeding risk in patients receiving RI [90,91].…”

Section: Conditions Associated With High Risk Of Bleedingmentioning

confidence: 99%

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Grisoglio

Brunetti

et al. 2017

European Journal of Internal Medicine

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“…54 Similarly, in the re-analysis of the ROCK-ET-AF trial, patients taking more than 10 drugs showed a non-significant trend of increased risk of major and minor bleeding, in the absence of stroke/SE modifications, compared to patients taking up to 4 drugs. 55 Moreover, patients on multidrug therapy have been shown to adhere less to therapy regimen than patients on little drug therapy. Contrary to Warfarin, for which about 36% of the patients have been shown not taking more than 20% of the planned doses, 56 all NOACs have demonstrated a good therapeutic adherence in over 85% of patients in real world clinical practice.…”

Section: Knowledge Gaps and Discussionmentioning

confidence: 99%

Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

2017

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Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.

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“…В исследо-вании ROCKET AF 0-4 исходно, помимо антикоагулянтов, до 4 лекарственных средств получали 36% больных, от 5 до 9 -51%, 10 и более -15% [23]. В целом увеличение числа принимаемых препаратов, особенно до 10 и более, было сопряжено с более высоким риском кровотечений и смерти, однако результаты сравнения ривароксабана и варфарина по первичным конечным точкам, характери-зующим эффективность и безопасность, не зависели от числа лекарственных средств, применявшихся в начале лечения.…”

Section: результаты анализа подгрупп в исследовании Rocket Afunclassified

Stroke Prevention in Non-Valvular Atrial Fibrillation. What Rocket Af Study Results Say

Yavelov¹

2017

Med. sov.

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И.С. ЯВЕЛОВ, д.м.н., в.н.с. отдела клинической кардиологии и молекулярной генетики Государственного научно-исследовательского центра профилактической медицины Минздрава России, Москва ПРОФИЛАКТИКА ИНСУЛЬТА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ О ЧЕМ ГОВОРЯТ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ ROCKET AF Длительное (неопределенно долгое) применение пероральных антикоагулянтов -наиболее действенный способ медика-ментозного предупреждения кардиоэмболических осложнений при фибрилляции предсердий (ФП). Этот подход превос-ходит по эффективности антиагреганты (как монотерапию ацетилсалициловой кислотой, так и ее сочетание с клопидогре-лом). В этом сообщении будут представлены факты, определившие представления о месте одного из пероральных анти-коагулянтов прямого действия -ривароксабана -в профилактике кардиоэмболических осложнений у больных с некла-панной ФП. Речь идет о рандомизированном контролируемом исследовании ROCKET AF, результаты которого стали основанием для одобрения ривароксабана к широкому применению при неклапанной ФП.Ключевые слова: неклапанная фибрилляция предсердий, инсульт, исследование ROCKET AF, ривароксабан. I.S. YAVELOV, PhD in medicine, leading research associate of the clinical cardiology and molecular genetics department of the State Scientific and Research Center of Preventive Medicine of the Ministry of Health of Russia, Moscow STROKE PREVENTION IN NON-VALVULAR ATRIAL FIBRILLATION. WHAT ROCKET AF STUDY RESULTS SAY Long-term (indefinitely long) use of oral anticoagulants is the most efficient method of medical prevention of cardioembolic complications of atrial fibrillation (AF). This approach is superior to the effectiveness of antiplatelet agents (as monotherapy by acetylsalicylic acid and its combination with clopidogrel). This summary will present the facts that determined ideas about the place of one of the oral anticoagulants of direct action -rivaroxaban -in the prevention of cardioembolic complications in patients with non-valvular atrial fibrillation. We are talking about a randomized, controlled study ROCKET AF, the results of which became the basis for the approval of rivaroxaban for widespread use in non-valcular atrial fibrillation.

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Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation

Cited by 154 publications

References 17 publications

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

Stroke Prevention in Non-Valvular Atrial Fibrillation. What Rocket Af Study Results Say

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