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 .
On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF
Background : Despite rapid clinical adoption of novel anticoagulants , it is unknown whether outcomes differ among patients with worsening renal function ( WRF ) taking these new drugs compared with warfarin .  We aim ed to determine whether the primary efficacy ( stroke or systemic embolism ) and safety ( major bleeding and nonmajor clinical ly relevant bleeding ) end points from the ROCKET AF trial ( Rivaroxaban Once-Daily , Oral , Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial ) differed among participants with WRF taking rivaroxaban and those taking warfarin .  Methods : After excluding patients without at least 1 follow-up creatinine measurement ( n=1624 ) , we included all remaining patients ( n=12 612 ) r and omly assigned to either rivaroxaban or dose-adjusted warfarin . On-treatment WRF ( a decrease of > 20 % from screening creatinine clearance measurement at any time point during the study ) was evaluated as a time-dependent covariate in Cox proportional hazards models . Results : Baseline characteristics were generally similar between patients with stable renal function ( n=9292 ) and WRF ( n=3320 ) .  Rates of stroke or systemic embolism , myocardial infa rct ion , and bleeding were also similar , but WRF patients experienced a higher incidence of vascular death versus stable renal function ( 2.21 versus 1.41 events per 100 patient-years ; P=0.026 ) . WRF patients who were r and omized to receive rivaroxaban had a reduction in stroke or systemic embolism compared with those taking warfarin ( 1.54 versus 3.25 events per 100 patient-years ) that was not seen in patients with stable renal function who were r and omized to receive rivaroxaban ( P=0.050 for interaction ) . There was no difference in major or nonmajor clinical ly relevant bleeding among WRF patients r and omized to warfarin versus rivaroxaban . Conclusions : Among patients with on-treatment WRF , rivaroxaban was associated with lower rates of stroke and systemic embolism compared with warfarin , without an increase in the composite bleeding end point . Clinical Trial Registration : URL : http://www . clinical trials.gov . Unique identifier : NCT00403767
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 .