Background
Results from a trial of rivaroxaban versus warfarin in 1280 Japanese patients with
atrial fibrillation (J-ROCKET AF) revealed that rivaroxaban was noninferior to warfarin
with respect to the principal safety outcome. In this subanalysis, we investigated
the safety and efficacy of rivaroxaban and warfarin in relation to patients' CHADS2 scores.
Results
The mean CHADS2 score was 3.25, and the most frequent scores were 3 and 4. No statistically significant
interactions were observed between principal safety outcome event rates and CHADS2 scores with respect to treatment groups (P value for interaction = .700). Irrespective of stratification into moderate- and
high-risk groups based on CHADS2 scores of 2 and 3 or more, respectively, no differences in principal safety outcome
event rates were observed between rivaroxaban- and warfarin-treated patients (moderate-risk
group: hazard ratio [HR], 1.06; 95% confidence interval [CI], .58-1.95; high-risk
group: HR, 1.11; 95% CI, .86-1.45; P value for interaction = .488). The primary efficacy end point rate in the rivaroxaban-treated
group was numerically lower than in the warfarin-treated group, regardless of risk
group stratification (moderate-risk group: HR, .46; 95% CI, .09-2.37; high-risk group:
HR, .49; 95% CI, .22-1.11; P value for interaction = .935).
Conclusion
This subanalysis indicated that the safety and efficacy of rivaroxaban compared with
warfarin were similar, regardless of CHADS2 score.
Key Words
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References
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke. 1991; 22: 983-988
- Comparison of 12 risk stratification schemes to predict stroke in patients with nonvalvular atrial fibrillation.Stroke. 2008; 39: 1901-1910
- Accumulation of risk factors increases risk of thromboembolic events in patients with nonvalvular atrial fibrillation.Circ J. 2006; 70: 651-656
- Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.JAMA. 2001; 285: 2864-2870
- Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation—the J-ROCKET AF study.Circ J. 2012; 76: 2104-2111
- Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N Engl J Med. 2011; 365: 883-891
- Rivaroxaban versus warfarin in Japanese patients with nonvalvular atrial fibrillation for the secondary prevention of stroke: a subgroup analysis of J-ROCKET AF.J Stroke Cerebrovasc Dis. 2013; (in press)
- The net clinical benefit of warfarin anticoagulation in atrial fibrillation.Ann Int Med. 2009; 151: 297-305
- Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.Thromb Haemost. 2012; 107: 584-589
- Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation.J Am Coll Cardiol. 2007; 50: 309-315
- Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature.Circulation. 2012; 126: 2381-2391
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.Eur Heart J. 2012; 33: 2719-2747
- 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation. 2011; 123: e269-e367
- Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control.Can J Cardiol. 2012; 28: 125-136
- Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).Eur Heart J. 2010; 31: 2369-2429
- A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.Chest. 2010; 138: 1093-1100
Article info
Publication history
Published online: August 19, 2013
Accepted:
July 15,
2013
Received:
July 12,
2013
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.07.021
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.