Rivaroxaban, Warfarin Comparable in Efficacy for Afib-Related Acute Ischemic Stroke

HealthDay News — For cases of mild atrial fibrillation (AF)-related acute ischemic stroke, rivaroxaban and warfarin are similarly safe and effective at preventing recurrent stroke, according to a study published in JAMA Neurology.

Keun-Sik Hong, MD, from Inje University in Goyang, South Korea, and colleagues compared rivaroxaban or warfarin sodium for prevention of early recurrent stroke in patients with AF-related acute ischemic stroke. Patients were randomized (1:1) to receive rivaroxaban (10 mg/day for 5 days followed by 15 or 20 mg/day; 95 participants) or warfarin with a target international normalized ratio of 2.0 to 3.0 (88 participants), for 4 weeks.

The researchers found that the two groups showed no differences in the primary composite end point (P =.49) or its individual components: new ischemic lesion (relative risk [RR], 0.83; 95% confidence interval, 0.54 to 1.26; P =.38) or new intracranial hemorrhage (RR, 1.10; 95% confidence interval, 0.70 to 1.71; P =.68).

Each group had 1 clinical ischemic stroke. All new intracranial hemorrhages were asymptomatic hemorrhagic transformations. Rivaroxaban was associated with reduced hospitalization length compared with warfarin (median, 4.0 days vs 6.0 days; P <.001).

“In mild AF-related acute ischemic stroke, rivaroxaban and warfarin had comparable safety and efficacy,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Bayer, which partially funded the study.

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Hong KS, Kwon SU, Lee SH, et al. Rivaroxaban vs warfarin sodium in the ultra-early period after atrial fibrillation-related mild ischemic stroke: a randomized clinical trial [published online September 11, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.2161