Warfarin vs Rivaroxaban: Which is Best Following Stroke?

Rivaroxaban was comparable to warfarin for early anticoagulation treatment among patients who experienced a mild atrial fibrillation (AF)–related acute ischemic stroke, according to the findings of a recent study.

The randomized, multicenter trial involved 195 patients who had experienced a mild AF-related stroke within the previous 5 days and were deemed suitable for early anticoagulation therapy. Patients were randomly assigned to receive rivaroxaban at 10 mg per day for 5 days followed by 15 or 20 mg per day or warfarin for 4 weeks. Magnetic resonance imaging was used to assess the primary endpoint after 4 weeks of treatment, which was the composite of new ischemic lesion or new intracranial hemorrhage. Secondary endpoints included hospitalization length and individual components of the primary endpoint.
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A total of 183 patients completed the magnetic resonance imaging component of the trial and were included in the final analysis. Of those, 95 received rivaroxaban and 88 received warfarin.

The researchers did not observe any differences between the rivaroxaban and warfarin groups for the primary endpoint (47 [49.5%] vs 48 [54.5%], respectively), new ischemic lesion (28 [29.5%] vs 31 out of 87 [35.6%)], or new intracranial hemorrhage (30 [31.6%] vs 25 of 87 [28.7%]). One clinical ischemic stroke occurred in each group, and all new intracranial hemorrhages were asymptomatic hemorrhagic transformations.

However, rivaroxaban was associated with a reduced length in hospital stay compared with warfarin (median 4 days vs 6 days, respectively).

“Rivaroxaban and warfarin had comparable safety and efficacy for early anticoagulation in mild atrial fibrillation–related acute ischemic stroke,” the researchers concluded.

—Melissa Weiss

Reference:

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