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    Home » Patients With Stable Coronary Disease and Atrial Fibrillation Are Best Treated With Rivaroxaban, Alone
    STROKE ALERT

    Patients With Stable Coronary Disease and Atrial Fibrillation Are Best Treated With Rivaroxaban, Alone

    December 1, 2019
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    Keywords

    stroke

    antiplatelet

    rivaroxaban

    coronary

    antithrombotic

    By Matthew E. Fink, MD

    Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College

    Dr. Fink reports no financial relationships relevant to this field of study.

    SOURCE: Yasuda S, Kaikita K, Akao M, et al. Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med 2019;381:
    1103-1113.

    Optimal antithrombotic therapy for stroke prevention in patients with atrial fibrillation continues to evolve. Subcategories may require different types of therapy. In this Japanese study, performed as a multicenter, open-label trial, 2,236 patients with atrial fibrillation, who had percutaneous coronary intervention or bypass grafting more than a year earlier and who were stable, were randomized to receive monotherapy with rivaroxiban alone or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary endpoint was a composite of stroke, systemic embolism, myocardial infarction, unstable angina, or death from any cause, and it was analyzed for noninferiority. The primary safety endpoint was major bleeding.

    This trial was stopped early because of increased mortality in the combination therapy group of rivaroxaban plus an antiplatelet agent. Monotherapy with rivaroxiban was noninferior to combination therapy for the primary efficacy endpoint, with event rates of 4.14% and 5.75% per patient year, respectively. Regarding the safety endpoint, rivaroxaban was superior with event rates of 1.62% and 2.76% per patient year, respectively, for a hazard ratio of 0.59 (P = 0.01). Because this study was performed only in Japan, caution should be taken before generalizing these findings to other countries with different ethnicities.

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    Neurology Alert

    View PDF
    Neurology Alert (Vol. 39, No. 4) - December 2019
    December 1, 2019

    Table Of Contents

    Stereoelectroencephalography in Surgical Evaluation of Intractable Epilepsy

    Prognosis in Small Fiber Neuropathy

    Treating Depression in Epilepsy: To Medicate or Not?

    Patients With Stable Coronary Disease and Atrial Fibrillation Are Best Treated With Rivaroxaban, Alone

    What Is the Optimal Blood Pressure for Secondary Prevention of Stroke?

    Smartwatches for the Diagnosis of Atrial Fibrillation

    Dual Antiplatelet Therapy Results in Increase in Serious Hemorrhages Following TIA or Minor Stroke

    Begin Test

    Buy this Issue/Course

    Financial Disclosure: Neurology Alert’s Editor in Chief Matthew Fink, MD; Peer Reviewer M. Flint Beal, MD; Editorial Group Manager Leslie Coplin; Editor Jason Schneider; Executive Editor Shelly Morrow Mark; and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no financial relationships relevant to this field of study.

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