Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF

Hankey, Graeme J.; Patel, Manesh R.; Stevens, Susanna R.; Becker, Richard C.; Breithardt, Günter; Carolei, Antonio; Diener, Hans‐Christoph; Donnan, Geoffrey A.; Halperin, Jonathan L.; Mahaffey, Kenneth W.; Mas, Jean‐Louis; Massaro, Ayrton Roberto; Norrving, Bo; Nessel, Christopher C.; Paolini, John F.; Roine, Risto O.; Singer, Daniel E.; Wong, Ka Sing; Califf, Robert M.; Fox, Keith A.A.; Hacke, Werner

doi:10.1016/s1474-4422(12)70042-x

Cited by 318 publications

(242 citation statements)

References 15 publications

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“…Ponadto proponuje się ponowne obrazowanie mózgu w celu określenia optymalnego momentu rozpoczęcia leczenia przeciwzakrzepowego u pacjentów z dużym udarem, u których istnieje ryzyko jego ukrwotocznienia. Długoterminowe OAC za pomocą VKA [363,[479][480][481] lub NOAC [482] przynosi korzyści u pacjentów z AF, którzy przeżyli udar mózgu. Stosowanie NOAC wydaje się wiązać z nieco lepszymi wynikami leczenia, co wynika głównie z rzadszego występowania krwawień wewnątrzczaszkowych i udarów krwotocznych (OR 0,44; 95% CI 0,32-0,62) [482].…”

Section: Leczenie śWieżego Udaru Niedokrwiennegounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

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2,339

4,206

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Section: Leczenie śWieżego Udaru Niedokrwiennegounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

Self Cite

2,339

4,206

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“…These NOACs have a wider therapeutic range and fewer drug and food interactions than VKAs, and were also proven to be useful for secondary stroke prevention in patients with NVAF 6, 7, 8. The effect of NOACs seems to be clearer in Asians than in non‐Asians 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Trends in Oral Anticoagulant Choice for Acute Stroke Patients with Nonvalvular Atrial Fibrillation in Japan: The SAMURAI-NVAF Study

Toyoda

Arihiro

Todo

et al. 2015

International Journal of Stroke

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BackgroundLarge clinical trials are lack of data on non‐vitamin K antagonist oral anticoagulants for acute stroke patients.AimTo evaluate the choice of oral anticoagulants at acute hospital discharge in stroke patients with nonvalvular atrial fibrillation and clarify the underlying characteristics potentially affecting that choice using the multicenter Stroke Acute Management with Urgent Risk‐factor Assessment and Improvement‐NVAF registry (ClinicalTrials.gov NCT01581502).MethodThe study included 1192 acute ischemic stroke/transient ischemic attack patients with nonvalvular atrial fibrillation (527 women, 77·7 ± 9·9 years old) between September 2011 and March 2014, during which three nonvitamin K antagonist oral anticoagulant oral anticoagulants were approved for clinical use. Oral anticoagulant choice at hospital discharge (median 23‐day stay) was assessed.ResultsWarfarin was chosen for 650 patients, dabigatran for 203, rivaroxaban for 238, and apixaban for 25. Over the three 10‐month observation periods, patients taking warfarin gradually decreased to 46·5% and those taking nonvitamin K antagonist oral anticoagulants increased to 48·0%. As compared with warfarin users, patients taking nonvitamin K antagonist oral anticoagulants included more men, were younger, more frequently had small infarcts, and had lower scores for poststroke CHADS 2, CHA 2 DS 2‐VASc, and HAS‐BLED, admission National Institutes of Health stroke scale, and discharge modified Rankin Scale. Nonvitamin K antagonist oral anticoagulants were started at a median of four‐days after stroke onset without early intracranial hemorrhage. Patients starting nonvitamin K antagonist oral anticoagulants earlier had smaller infarcts and lower scores for the admission National Institutes of Health stroke scale and the discharge modified Rankin Scale than those starting later. Choice of nonvitamin K antagonist oral anticoagulants was independently associated with 20‐day or shorter hospitalization (OR 2·46, 95% CI 1·87–3·24).ConclusionsWarfarin use at acute hospital discharge was still common in the initial years after approval of nonvitamin K antagonist oral anticoagulants, although nonvitamin K antagonist oral anticoagulant users increased gradually. The index stroke was milder and ischemia‐risk indices were lower in nonvitamin K antagonist oral anticoagulant users than in warfarin users. Early initiation of nonvitamin K antagonist oral anticoagulants seemed safe.

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“…The analysis of the results related to patients with history of previous TIA/stroke enclosed in these trials (secondary prevention) is of great interest because of the related consequences in clinical practice. [16][17][18] Patient cohorts with previous TIA/stroke enrolled in the three RCTs numbered: 1195 for the RE-LY 110 mg, 1233 for the RE-LY 150 mg, 3754 for the ROCKET-AF, 1694 for the ARISTOTLE studies, respectively, compared with 4819 (RE-LY 110), 4843 (RE-LY 150), 3377 (ROCKET-AF), 7426 (ARISTOTLE) patients in primary prevention. [16][17][18] There was a difference in the percentage of patients with a history of TIA/stroke enrolled in the three RCTs in a comparison of the ROCKET-AF trial with RE-LY and ARISTOTLE.…”

Section: Reviewmentioning

confidence: 99%

“…15 Of utmost significance is the overall relative risk reduction (RRR) of 55% of intracranial bleedings associated with DOACs when compared to warfarin. [16][17][18] The results of the three phase III RCTs on DOACs in NVAF have been described in detail and commented on in a previous article. 19 The details of these RCTs are summarized in Tables 1-3. The results of these phase III RCTs have already been accepted by the scientific community and DOACs are now included in the latest guidelines on clinical management of NVAF published by the most important international scientific Societies, such as the American College of Chest Physicians (ACCP) and the European Society of Cardiology (ESC).…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

Masotti¹,

Napoli

Ageno

et al. 2013

Ital J Med

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The patients with non-valvular atrial fibrillation (NVAF), both permanent and paroxysmal, and history of previous transient ischemic attack (TIA) or stroke represent a category of patients at high risk of new embolic events, independently of the presence of other risk factors. In these patients, national and international guidelines recommend oral anticoagulants as first choice for antithrombotic prevention. Direct oral anticoagulants (DOACs) have been demonstrated to be not inferior to warfarin for many end points in NVAF patients in terms of efficacy and safety. The post hoc analysis in selected subgroups of patients enrolled in the three mega trials of phase III comparing DOACs (RE-LY, ROCKET-AF and ARISTOTLE) with warfarin help to evaluate whether superiority and non-inferiority persist in these subgroups. Here, patients with NVAF and history of previous TIA/stroke receiving DOACs as secondary prevention are compared with patients with the same characteristics receiving warfarin. An analysis of these patients has been recently published (separately for each of three DOACs). This analysis shows that DOACs maintain their non-inferiority when compared with warfarin in secondary prevention, representing a real alternative in this context of patients at high risk for ischemic and bleeding events.

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Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF

Cited by 318 publications

References 15 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Trends in Oral Anticoagulant Choice for Acute Stroke Patients with Nonvalvular Atrial Fibrillation in Japan: The SAMURAI-NVAF Study

Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

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