TY - JOUR
T1 - Net clinical benefit of rivaroxaban compared with warfarin in atrial fibrillation
T2 - Results from ROCKET AF
AU - Barnett, Adam S.
AU - Cyr, Derek D.
AU - Goodman, Shaun G.
AU - Levitan, Bennett S.
AU - Yuan, Zhong
AU - Hankey, Graeme J.
AU - Singer, Daniel E.
AU - Becker, Richard C.
AU - Breithardt, Günter
AU - Berkowitz, Scott D.
AU - Halperin, Jonathan L.
AU - Hacke, Werner
AU - Mahaffey, Kenneth W.
AU - Nessel, Christopher C.
AU - Fox, Keith A.A.
AU - Patel, Manesh R.
AU - Piccini, Jonathan P.
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2018/4/15
Y1 - 2018/4/15
N2 - Aims: The aim of this study was to determine the net clinical benefit (NCB) of rivaroxaban compared with warfarin in patients with atrial fibrillation. Methods: This was a retrospective analysis of 14,236 patients included in ROCKET AF who received at least one dose of study drug. We analyzed NCB using four different methods: (1) composite of death, stroke, systemic embolism, myocardial infarction, and major bleeding; (2) method 1 with fatal or critical organ bleeding substituted for major bleeding; (3) difference between the rate of ischemic stroke or systemic embolism minus 1.5 times the difference between the rate of intracranial hemorrhage; and (4) weighted sum of differences between rates of death, ischemic stroke or systemic embolism, intracranial hemorrhage, and major bleeding. Results: Rivaroxaban was associated with a lower risk of the composite outcome of death, myocardial infarction, stroke, or systemic embolism (rate difference per 10,000 patient-years [RD] = − 86.8 [95% CI − 143.6 to − 30.0]) and fatal or critical organ bleeding (− 41.3 [− 68 to − 14.7]). However, rivaroxaban was associated with a higher risk of major bleeding other than fatal or critical organ bleeding (55.9 [14.7 to 97.2]). Method 1 showed no difference between treatments (− 35.5 [− 108.4 to 37.3]). Methods 2–4 favored treatment with rivaroxaban (2: − 96.8 [− 157.0 to − 36.8]; 3: − 65.2 [− 112.3 to − 17.8]; 4: − 54.8 [− 96.0 to − 10.2]). Conclusions: Rivaroxaban was associated with favorable NCB compared with warfarin. The NCB was attributable to lower rates of ischemic events and fatal or critical organ bleeding.
AB - Aims: The aim of this study was to determine the net clinical benefit (NCB) of rivaroxaban compared with warfarin in patients with atrial fibrillation. Methods: This was a retrospective analysis of 14,236 patients included in ROCKET AF who received at least one dose of study drug. We analyzed NCB using four different methods: (1) composite of death, stroke, systemic embolism, myocardial infarction, and major bleeding; (2) method 1 with fatal or critical organ bleeding substituted for major bleeding; (3) difference between the rate of ischemic stroke or systemic embolism minus 1.5 times the difference between the rate of intracranial hemorrhage; and (4) weighted sum of differences between rates of death, ischemic stroke or systemic embolism, intracranial hemorrhage, and major bleeding. Results: Rivaroxaban was associated with a lower risk of the composite outcome of death, myocardial infarction, stroke, or systemic embolism (rate difference per 10,000 patient-years [RD] = − 86.8 [95% CI − 143.6 to − 30.0]) and fatal or critical organ bleeding (− 41.3 [− 68 to − 14.7]). However, rivaroxaban was associated with a higher risk of major bleeding other than fatal or critical organ bleeding (55.9 [14.7 to 97.2]). Method 1 showed no difference between treatments (− 35.5 [− 108.4 to 37.3]). Methods 2–4 favored treatment with rivaroxaban (2: − 96.8 [− 157.0 to − 36.8]; 3: − 65.2 [− 112.3 to − 17.8]; 4: − 54.8 [− 96.0 to − 10.2]). Conclusions: Rivaroxaban was associated with favorable NCB compared with warfarin. The NCB was attributable to lower rates of ischemic events and fatal or critical organ bleeding.
KW - Atrial fibrillation
KW - Net clinical benefit
KW - Rivaroxaban
UR - http://www.scopus.com/inward/record.url?scp=85042663661&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2017.06.110
DO - 10.1016/j.ijcard.2017.06.110
M3 - Article
C2 - 29506743
AN - SCOPUS:85042663661
SN - 0167-5273
VL - 257
SP - 78
EP - 83
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -