Rivaroxaban alternative option for elderly

Rivaroxaban (Xarelto, Bayer Pharma/Janssen Pharmaceuticals) may be used as an alternative to warfarin in older patients with atrial fibrillation.

In a secondary analysis of the ROCKET-AF trial, which initially showed that rivaroxaban was noninferior to warfarin in atrial fibrillation, the new study found that the efficacy and safety of rivaroxaban relative to warfarin did not differ with age.

"The main finding of this study is that in elderly patients with non-valvular atrial fibrillation at high risk of stroke, anticoagulation with the oral factor Xa inhibitor rivaroxaban was as effective as adjusted-dose warfarin," said lead author Jonathan L. Halperin, MD, from the Icahn School of Medicine at Mount Sinai, New York, NY.

"Although rivaroxaban caused more clinically relevant non-major bleeding, it was associated with a lower risk of intracranial bleeding, which is a particular concern in the elderly."

The new findings were published online June 3, 2014 in Circulation.

Atrial fibrillation is in many ways a disease of the elderly, who face high rates of disabling stroke if untreated but risk bleeding during anticoagulation with warfarin. But warfarin requires routine blood test monitoring, making it difficult for many elderly patients to sustain treatment. Conversely, rivaroxaban is an oral drug that is given once daily.

"Simplifying anticoagulation management for elderly patients is a substantial advantage, and the availability of rivaroxaban and other factor Xa inhibitors may allow anticoagulation of a higher proportion of high-risk elderly patients with atrial fibrillation for protection against ischemic stroke," explained Dr Halperin.

Rivaroxaban proved noninferior to warfarin in preventing stroke in the ROCKET AF trial of over 14 000 patients, and had comparable rates of bleeding and significantly lower rates of brain hemorrhage. The new analysis compared outcomes in 6,229 patients ≥75 years old with younger patients.

The takeaway message from this is that among elderly patients with atrial fibrillation, rates of stroke and major bleeding were higher than those in younger patients, but the relative efficacy and safety of rivaroxaban compared with warfarin did not differ with age, according to Dr Halperin. "The results support use of rivaroxaban as an alternative to warfarin in elderly patients with atrial fibrillation."