Preview

Rational Pharmacotherapy in Cardiology

Advanced search

The Anticoagulation in Patients with Atrial Fibrillation: Rivaroxaban and Warfarin

https://doi.org/10.20996/1819-6446-2016-12-5-553-557

Full Text:

Abstract

Aim. To study the effect of rivaroxaban compared with warfarin on the incidence of cardioembolic stroke and systemic thromboembolic complications (TEC), bleeding in patients with non-valvular atrial fibrillation (AF).

Material and methods. Patients (n=126) older than 18 years, appealed to the Cardiology Clinic with non-valvular AF were included into an open non-randomized study. The patients were divided into 2 groups based on their socio-economic status: 77 patients received rivaroxaban and 49 - warfarin. The incidence of acute coronary syndrome, ischemic stroke and other TEC, bleeding as well as (only for patients taking warfarin) international normalized ratio (INR) and time in the therapeutic INR range were evaluated.

Results. The incidence of ischemic stroke was not significantly different between groups, at the same time the incidence of other TEC was significantly higher in the warfarin group (0 vs 8%, p=0.011). The incidence of minor bleedings was significantly prevailed in warfarin group (0 vs 20%; p=0.0004). The time in the target INR range in the warfarin group was only 43%. 93.5% of patients continued to receive rivaroxaban after 9 months, and warfarin – 67.4% of patients.

Conclusion. The results of our own clinical studies of rivaroxaban in patients with non-valvular AF have demonstrated efficacy comparable to that of warfarin. Rivaroxaban was superior to warfarin in safety.

About the Authors

I. Yu. Koroleva
Nizhny Novgorod State Medical Academy. Minina i Pozharskogo pl. 10/1, Nizhny Novgorod, 603950 Russia
Russian Federation

MD, PhD, Professor of Chair of Hospital Therapy, Nizhny Novgorod State Medical Academy



I. V. Kolesnichenko
City Clinical Hospital № 5. Nesterova ul. 34B, Nizhny Novgorod, 603950 Russia
Russian Federation

MD, PhD, Cardiologist of Cardiology Dispensary and Rheumatology Center, City Clinical Hospital №5 (Nizhny Novgorod)



V. P. Nosov
Nizhny Novgorod State Medical Academy. Minina i Pozharskogo pl. 10/1, Nizhny Novgorod, 603950 Russia
Russian Federation

MD, PhD, Professor of Chair of Hospital Therapy, Nizhny Novgorod State Medical Academy



M. V. Zlobin
Nizhny Novgorod State Medical Academy. Minina i Pozharskogo pl. 10/1, Nizhny Novgorod, 603950 Russia
Russian Federation

MD, Clinical Resident of Chair of Hospital Therapy, Nizhny Novgorod State Medical Academy



D. I. Abelevich
City Clinical Hospital № 5. Nesterova ul. 34B, Nizhny Novgorod, 603950 Russia
Russian Federation

MD, Cardiologist of Cardiology Dispensary and Rheumatology Center, City Clinical Hospital №5 (Nizhny Novgorod)



References

1. Apostolakis S, Sullivan RM, Olshansky B, Lip GYH. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin. Chest. 2013; 144: 1555–63. doi: 10.1378/chest.13- 0054.

2. Rosinio S, Keylani AM, D'Agostino DC. Pharmacology, benefits, unaddressed questions, and pragmatic issues of the newer oral anticoagulants for stroke prophylaxis in non-valvular atrial fibrillation and proposal of a management algorithm. Inter J Cardiol. 2014; 174: 471- 83. doi: 10.1016/j.ijcard.2014.04.179.

3. Harrington AR, Armstrong EP, Nolan Jr PE, Malone DC. Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation. Stroke. 2013;44:1676-81. doi: 10.1161/STROKEAHA.111.000402.

4. Lip GYH, Lane DA. Stroke prevention in atrial fibrillation: systematic review. JAMA. 2015; 313 (19): 1950-62. doi: 10.1001/jama.2015.4369.

5. Savelieva I, Camm AJ. Practical Considerations for Using Novel OralAnticoagulants in Patients With Atrial Fibrillation. Clin Cardiol. 2014;37, 1: 32-47. doi: 10.1002/clc.22204.

6. Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011. doi: 10.1002/14651858.CD000011.

7. Saini SD, Schoenfeld P, Kaulback K, et al. Effect of medication dosing frequency on adherence in chronic diseases. Am J Manag Care. 2009; 15: e22-e33.

8. Coleman CI, Roberts MS, Sobieraj DM, et al. Effect of dosing frequency on chronic cardiovascular disease medication adherence. Curr Med Res Opin. 2012; 28: 669-80. doi: 10.1185/03007995.2012.677419.

9. Barrett YC, Wang Z, Frost C, et al. Clinical laboratory measurement of direct Factor Xa inhibitors: anti-Xa assay is preferable to prothrombin time assay. Thromb Haemost. 2010; 104: 1263-71. doi: 10.1160/TH10-05-0328.

10. Coleman CI, Limone B, Sobieraj DM, et al. Dosing frequency and medication adherence in chronic disease. J Manag Care Pharm. 2012; 18: 527-39. doi: 10.18553/jmcp.2012.18.7.527.

11. Camm AJ, Amarenco P, Haas S, et al. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Eur Heart J. 2016;37(14):1145-53. doi: 10.1093/eurheartj/ehv466.

12. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. doi: 10.1056/NEJMoa1009638.

13. Tamayo S, Frank Peacock W, Patel M, et al. Characterizing major bleeding in patients with nonvalvular atrial fibrillation: a pharmacovigilance study of 27 467 patients taking rivaroxaban. Clin Cardiol. 2015;38(2):63-8. doi: 10.1002/clc.22373.

14. Cunningham A, Stein CM, Chung CP, et al. An automated database case definition for serious bleeding related to oral anticoagulant use. Pharmacoepidemiol Drug Saf. 2011;20(6):560-6. doi: 10.1002/pds.2109.

15. Laliberte ́F, Cloutier M, Nelson WW, et al. Real-world comparative effectiveness and safety of rivaroxaban and warfarin in nonvalvular atrial fibrillation patients. Curr Med Res Opin. 2014;30:1317-25. doi: 10.1185/03007995.2014.907140.

16. Nelson WW, Song X, Coleman CI, et al. Medication persistence and discontinuation of rivaroxaban versus warfarin among patients with non-valvular atrial fibrillation. Curr Med Res Opin. 2014;30:2461-9. doi: 10.1185/03007995.2014.933577.


Review

For citations:


Koroleva I.Yu., Kolesnichenko I.V., Nosov V.P., Zlobin M.V., Abelevich D.I. The Anticoagulation in Patients with Atrial Fibrillation: Rivaroxaban and Warfarin. Rational Pharmacotherapy in Cardiology. 2016;12(5):553-557. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-5-553-557

Views: 724


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)