Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .
Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial).
BACKGROUND The prevalence of both atrial fibrillation ( AF ) and diabetes mellitus ( DM ) are rising , and these conditions often occur together . Also , DM is an independent risk factor for stroke in patients with AF . We aim ed to examine the safety and efficacy of rivaroxaban vs warfarin in patients with nonvalvular AF and DM in a prespecified secondary analysis of the ROCKET AF trial . METHODS We stratified the ROCKET AF population by DM status , assessed associations with risk of outcomes by DM status and r and omized treatment using Cox proportional hazards models , and tested for interactions between r and omized treatments . For efficacy , primary outcomes were stroke ( ischemic or hemorrhagic ) or non- central nervous system embolism . For safety , the primary outcome was major or nonmajor clinical ly relevant bleeding . RESULTS The 5,695 patients with DM ( 40 % ) in ROCKET AF were younger , were more obese , and had more persistent AF  , but fewer had previous stroke  ( the CHADS2 score includes DM and stroke ) . The relative efficacy of  rivaroxaban and  warfarin for prevention of stroke and systemic embolism was similar in patients with ( 1.74 vs 2.14/100 patient-years , hazard ratio [ HR ] 0.82 ) and without ( 2.12 vs 2.32/100 patient-years , HR 0.92 ) DM ( interaction P = .53 ) . The safety of rivaroxaban vs warfarin regarding major bleeding ( HRs 1.00 and 1.12 for patients with and without DM , respectively ; interaction P = .43 ) , major or nonmajor clinical ly relevant bleeding ( HRs 0.98 and 1.09 ; interaction P = .17 ) , and intracerebral hemorrhage ( HRs 0.62 and 0.72 ; interaction P = .67 ) was independent of DM status . Adjusted exploratory analyses suggested 1.3- , 1.5- , and 1.9-fold higher 2-year rates of stroke , vascular mortality , and myocardial infa rct ion in DM patients . CONCLUSIONS AND RELEVANCE The relative efficacy and safety of rivaroxaban vs warfarin was similar in patients with and without DM , supporting use of rivaroxaban as an alternative to warfarin in diabetic patients with AF
Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .