Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation

• Published in: The New England journal of medicine Vol. 365; no. 10; pp. 883 - 891
• Main Authors: Patel, Manesh R, Mahaffey, Kenneth W, Garg, Jyotsna, Pan, Guohua, Singer, Daniel E, Hacke, Werner, Breithardt, Günter, Halperin, Jonathan L, Hankey, Graeme J, Piccini, Jonathan P, Becker, Richard C, Nessel, Christopher C, Paolini, John F, Berkowitz, Scott D, Fox, Keith A.A, Califf, Robert M
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 08.09.2011
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atrial Fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Biological and medical sciences; Bleeding; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Double-Blind Method; Drug dosages; Embolism; Embolism - epidemiology; Embolism - prevention & control; Embolisms; Equity; Equity stake; Fees & charges; Female; Fibrillation; General aspects; Heart; Heart attacks; Hemorrhage; Hemorrhage - chemically induced; Humans; Intention to Treat Analysis; Ischemia; Life Sciences; Male; Medical sciences; Middle Aged; Morpholines; Morpholines - administration & dosage; Morpholines - adverse effects; Morpholines - therapeutic use; Motivation; Pharmaceuticals; Prevention; R&D; Research & development; Risk factors; Rivaroxaban; Stroke; Stroke - epidemiology; Stroke - prevention & control; Thiophenes; Thiophenes - administration & dosage; Thiophenes - adverse effects; Thiophenes - therapeutic use; Thromboembolism; Treatment Outcome; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects; Warfarin - therapeutic use; United States > US; Warfarin; Arrhythmia; Coumarine derivatives; Atrial fibrillation; Cardiovascular disease; Anticoagulant; Excitability disorder; Medicine; Antivitamin K; Rivaroxaban; Heart disease; Antithrombotic agent; Comparative study
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1009638

In this trial, 14,264 patients with atrial fibrillation were randomly assigned to receive either rivaroxaban or warfarin. In a per-protocol, as-treated analysis, rivaroxaban was noninferior to warfarin with respect to the primary end point of stroke or systemic embolism. Atrial fibrillation is associated with an increase in the risk of ischemic stroke by a factor of four to five 1 and accounts for up to 15% of strokes in persons of all ages and 30% in persons over the age of 80 years. 2 The use of vitamin K antagonists is highly effective for stroke prevention in patients with nonvalvular atrial fibrillation and is recommended for persons at increased risk. 3 – 5 However, food and drug interactions necessitate frequent coagulation monitoring and dose adjustments, requirements that make it difficult for many patients to use such drugs in clinical practice. 6 – 8 Rivaroxaban is . . .