Rivaroxaban, Dabigatran Reduce Ischemic Stroke and Intracranial Hemorrhage in Those With Nonvalvular Atrial Fibrillation

A large meta-analysis of 95 studies published in the Journal of Market Access and Health Policy, showed that treatment with rivaroxaban (Xarelto; Janssen Pharmaceuticals, Titusville, NJ) significantly lowered the risk of ischemic stroke and intracranial hemorrhage (ICH) vs warfarin in patients with nonvalvular atrial fibrillation (NVAF). Treatment with rivaroxaban reduced the risk of the 2 composite outcomes: ischemic stroke and systemic embolism with and without all-cause mortality. There were no differences in the rates of heart attack, venous thromboembolism (VTE), hemorrhagic stroke (HS), or major bleeding for those treated with rivaroxaban vs warfarin. Rivaroxaban was associated with a higher risk of gastrointestinal bleeding. 

The analysis also evaluated patients treated with dabigatran (Pradaxa; Boehringer Ingelheim, Ridgefield, CT) and found they also had lower risk of ischemic stroke. Additionally, those treated with dabigatran had reduced all-cause mortality, VTE, HS, and ICH compared to those treated with warfarin. There were no differences in risk of heart attack or the composite measures with dabigatran vs warfarin. 

The study also compared treatment with apixaban (Eliquis; Bristol-Myers Squibb, New York, NY) to treatment with warfarin and found no difference in rates of ischemic stroke or the composite of ischemic stroke and SE.  

Participants in all studies analyzed were adults with NVAF, and outcomes measured included ischemic stroke; all-cause mortality; heart attack; venous thromboembolism (VTE); a composite of ischemic stroke and systemic embolism (SE); and a composite of ischemic stroke, SE, and all-cause mortality. 

First author Craig Coleman, PharmD, professor of pharmacy practice, University of Connecticut said, "Our findings show that certain NOACs, like rivaroxaban, are performing exceptionally well, and that physicians should feel confident prescribing them to prevent strokes that can often result in irreversible harm and even death."