NEW ORLEANS—Rivaroxaban is associated with a 40% lower risk of intracranial hemorrhage than warfarin among patients with atrial fibrillation and a moderate to high risk of stroke, according to research presented at the 2012 International Stroke Conference. In addition, patients with poor renal functioning, previous stroke, and high blood pressure are more likely to experience intracerebral hemorrhage, said Graeme J. Hankey, MD, consultant neurologist and head of the Stroke Unit at Royal Perth Hospital in Australia.
Dr. Hankey and his colleagues conducted a subanalysis of the Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial. In the main study, patients who took rivaroxaban were 12% less likely to experience a stroke than patients who took warfarin. For the subanalysis, Dr. Hankey and his colleagues sought to determine the independent, significant predictors of intracranial hemorrhage among patients with atrial fibrillation. The trial followed 14,264 patients with atrial fibrillation who were randomly assigned to take an adjusted dose of warfarin or 20 mg of rivaroxaban daily.
The investigators followed up with patients at one, two, and four weeks, and at monthly intervals thereafter. The median follow-up time was 1.9 years. The study’s overall primary outcome was stroke or systemic embolism, and Dr. Hankey chose intracranial hemorrhage as the primary outcome of the substudy.