Alternative Drug Better Treats Heart Arrhythmia

Rivaroxaban is a solid alternative for warfarin

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) A medication considered the standard for preventing stroke in heart arrhythmia patients may not be as effective as an anti-clotting drug that also boasts fewer side effects.

Doctors routinely prescribe warfarin, though rivaroxaban also is effective for preventing stroke and blood clots in those with common irregular heartbeat problem atrial fibrillation.

The latter also has fewer reports of intracranial and fatal bleeding.

"Talk to a physician about which arrhythmia drug to take."

Dr. Manesh R. Patel, the study's lead author and an assistant professor of medicine at Duke University School of Medicine, noted that warfarin has been a standard treatment for decades.  However, it requires rigorous monitoring to ensure accurate dosing levels and can present food and drug interaction problems that are problematic for both doctors and patients.

He said his global research trial convincingly showed that rivaroxaban is a solid alternative for warfarin with no increase in bleeding. Warfarin has been shown to reduce the risk of stroke in atrial fibrillation patients by between half to two-thirds, though it tends to cause increased bleeding.

The ROCKET AF (Rivaroxaban once daily oral direct factor xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation) study followed 14,264 patients with atrial fibrillation with a history of stroke or risk factors for stroke. They randomly received either rivaroxaban or warfarin at one of more than 1,100 participating health centers in 45 countries.

The study showed that rivaroxaban was not inferior to warfarin, and appeared to be slightly more beneficial. Rates of bleeding and adverse events were similar between treatment groups. However, patients treated with rivaroxaban had significantly fewer intracranial hemorrhages, critical organ bleeds and bleeding-related deaths as compared to warfarin.

Patients treated with rivaroxaban showed increased rates of hemoglobin/hematocrit drop and transfusions compared to warfarin.

Though the study was sponsored by Johnson & Johnson Pharmaceutical Research & Development and Bayer Healthcare, the trial was designed by leaders in the field, independent oversight was provided and the trial results were later independently reviewed.

The research was published in the New England Journal of Medicine.

Reviewed by: 
Review Date: 
August 10, 2011
Last Updated:
August 13, 2011