Risk of Stroke Outcomes in Atrial Fibrillation Patients Treated with Rivaroxaban and Warfarin

Abstract

Objectives: In a previous real-world study, rivaroxaban reduced the risk of stroke overall and severe stroke compared with warfarin in patients with nonvalvular atrial fibrillation (NVAF). The aim of this study was to assess the reproducibility in a different database of our previously observed results (Alberts M, et al. Stroke. 2020;51:549-555) on the risk of severe stroke among NVAF patients in a different population treated with rivaroxaban or warfarin. Material and Methods: This retrospective cohort study included patients from the IBM Ò MarketScan Ò Commercial and Medicare databases (2011-2019) who initiated rivaroxaban or warfarin after a diagnosis of NVAF, had 6 months of continuous health plan enrollment, had a CHA 2 DS 2-VASc score 2, and had no history of stroke or anticoagulant use. Patient data were assessed until the earliest occurrence of a primary inpatient diagnosis of stroke, death, end of health plan enrollment, or end of study. Stroke severity was defined by National Institutes of Health Stroke Scale (NIHSS) score, imputed by random forest model. Cox proportional hazard regression was used to compare risk of stroke between cohorts, balanced by inverse probability of treatment weighting. Results: The mean observation period from index date to either stroke, or end of eligibility or end of data was 28 months. Data from 13,599 rivaroxaban and 39,861 warfarin patients were included. Stroke occurred in 272 rivaroxaban-treated patients (0.97/100 person-years [PY]) and 1,303 warfarin-treated patients (1.32/ 100 PY). Rivaroxaban patients had lower risk for stroke overall (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.76À0.88) and for minor (NIHSS 1 to <5; HR, 0.83; 95% CI, 0.74À0.93), moderate (NIHSS 5 to <16; HR, 0.88; 95% CI, 0.78À0.99), and severe stroke (NIHSS 16 to 42; HR, 0.44; 95% CI, 0.22À0.91). Conclusions: The results of this study in a larger population of NVAF patients align with previous realworld findings and the ROCKET-AF trial by showing improved stroke prevention with rivaroxaban versus warfarin across all stroke severities.

Combination of platelet-to-lymphocyte ratio and D-dimer for the identification of cardiogenic cerebral embolism in non-valvular atrial fibrillation

“…Furthermore, different types of stroke (e.g., large artery atherosclerosis stroke) and atrial fibrillation (e.g., valvular atrial fibrillation) should be considered to assess the specificity of clinical application of the risk score for identifying CCE in NVAF patients. (3) Some previous studies indicated that non-vitamin K antagonist oral anticoagulants may have better effect for stroke prevention than warfarin in NVAF ( 8 , 30 , 31 ), which is inconsistent with our findings. Less participants with the use of rivaroxaban are included in the present CCE patients, which may be the main cause to result in the current findings.…”

“…(3) Some previous studies indicated that non-vitamin K antagonist oral anticoagulants may have better effect for stroke prevention than warfarin in NVAF (8,30,31), which is inconsistent with our findings. Less participants with the use of rivaroxaban are included in the present CCE patients, which may be the main cause to result in the current findings.…”

Healthcare Resource Utilization and Costs of Rivaroxaban Versus Warfarin Among Non-valvular Atrial Fibrillation (NVAF) Patients with Diabetes in a US Population

“…These HRU and cost reductions associated with rivaroxaban could potentially reflect differences in its clinical profile relative to warfarin based on evidence from real-world clinical practice [ 29 , 30 , 48 – 50 ]. In prior studies among NVAF patients with diabetes, rivaroxaban has been associated with improved clinical outcomes along with HRU benefits relative to warfarin [ 26 , 27 ].…”

Prognostic Value of Platelet-to-Lymphocyte Ratio Combined with CHA2DS2-VASc Score for Nonvalvular Atrial Fibrillation Induced Cardiogenic Cerebral Embolism

“…In addition, we further analyzed the influence of different anticoagulant drugs on the incidence of CCE, and the results showed that our conclusions were consistent with those of previous studies, indicated that non-vitamin K antagonist oral anticoagulants may have better effect for stroke prevention than warfarin in NVAF, which provided a good inspiration for our clinical drug selection. 32 , 33 …”

“…In addition, we further analyzed the influence of different anticoagulant drugs on the incidence of CCE, and the results showed that our conclusions were consistent with those of previous studies, indicated that non-vitamin K antagonist oral anticoagulants may have better effect for stroke prevention than warfarin in NVAF, which provided a good inspiration for our clinical drug selection. 32,33 Although we have fully evaluated the potential clinical significance of NVAF related CCE risk scores, some limitations could be noted, and the retrospective nature of this investigation could have given rise to some biases. First, because the selected patients were all inpatients in the department of cardiology of our hospital, there is a selection bias.…”