title: Stroke prevention with rivaroxaban in higher-risk populations with atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. Rivaroxaban, an oral factor Xa inhibitor, is approved for the prevention of stroke in patients with non-valvular AF. In the pivotal phase III trial ROCKET AF, rivaroxaban demonstrated non-inferiority compared with warfarin for reducing the risk of stroke or systemic embolism (SE) in patients with AF (intention-to-treat analysis), without an increased risk of major bleeding. Superior efficacy vs. warfarin was achieved while patients were on study medication. Other direct oral factor Xa inhibitors have completed phase III clinical trials in this indication. Compared with warfarin, apixaban (in the ARISTOTLE trial) and edoxaban (in the ENGAGE-AF trial) were shown to be superior or non-inferior, respectively, for reduction in stroke or SE risk in patients with AF. Baseline stroke risk, as indicated by CHADS2 scores, was lower in patients in the ARISTOTLE and ENGAGE-AF trials than in ROCKET AF.
  
  
  OBJECTIVE
  This review discusses the main findings from ROCKET AF, specifically examining recent subgroup analyses investigating rivaroxaban use across various patient types at high risk for adverse outcomes, including those with prior stroke or transient ischaemic attack, reduced renal function, prior myocardial infarction, peripheral artery disease, heart failure or patients aged ≥ 75 years and those resident in East Asia.
  
  
  CONCLUSIONS
  These subgroup analyses demonstrate that the treatment effect for rivaroxaban vs. warfarin is broadly consistent across a wide range of patient groups, with respect to both efficacy and safety.
authors: Department of Neurology, University of Essen, Essen, Germany.
authors: H-C
authors: HC
authors: Diener
authors: Cardiology Clinical Services, Mount Sinai School of Medicine, New York, NY, USA.
authors: J L
authors: JL
authors: Halperin
authors: Department of Cardiology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: K
authors: K
authors: Fox
authors: School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.|Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia.
authors: G J
authors: GJ
authors: Hankey
mesh_terms: D000284:Administration, Oral; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D006801:Humans; D011159:Population Surveillance; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban