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.

References

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