Rivaroxaban versus Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: A Systematic Review and Meta-analysis.
Presenter
Nischit Baral, MBBS, McLaren Flint, grand blanc, MI
Nischit Baral, MBBS1, Govinda Adhikari, MD2, Rohit Rauniyar, MD2, Mahin R Khan, MD3, Hafiz Muhammad Waqas Khan, MD4, Sakiru O Isa, MD5, Pramod Savarapu, MD6, Maxwell Akanbi, MD, PHD2, Basel Abdelazeem, MD2, Arvind Kunadi, MD6, Parul Sud, Md6 and Hameem U. Changezi, M.D.7, (1)McLaren Flint, grand blanc, MI, (2)McLaren Flint - Michigan State University, FLINT, MI, (3)McLaren Flint, Flint, MI, (4)Icahn School of Medicine at Mount Sinai Morningside, Weston, WI, (5)McLaren Flint - Michigan State University, Flint, MI, (6)McLaren Flint - Michigan State University, grand blanc, MI, (7)Regional Cardiology Associates, PLC, Grand Blanc, MI
Keywords: Pharmacotherapy
Background
Rivaroxaban is a Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) widely used for the treatment of non-valvular Atrial Fibrillation (AF). However, there are ongoing concerns regarding its safety and efficacy in patients with AF and Valvular Heart Disease (VHD) including Bioprosthetic valves. We conducted an up-to-date meta-analysis to determine the efficacy and safety of Rivaroxaban in patients with AF and VHD compared to Warfarin.
Methods
We conducted a systematic review with meta-analysis of randomized controlled trials (RCTs) and cohort studies published till January 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), Scopus (Elsevier), Cochrane database including only RCTs and Cohort studies. The Downs and Black questionnaire tool was used to assess the quality of included studies and results reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We used random-effects model using the hazard ratio (HR) with 95% confidence interval (95%CI) to pool the data regarding the efficacy and safety using Rev Man 5.4 software.
Results
The pooled data from 4 studies showed Stroke and Systemic embolism in 88 of 4258 (2.06%) patients in the rivaroxaban group and 351 of 18878 (1.85%) patients in the warfarin group. The pooled result showed that the risk of stroke and systemic embolism was comparable across both groups (HR 0.76, 95%CI:0.55-1.06; I2=35%). Rivaroxaban and warfarin were also associated with similar risks of intracranial hemorrhage (HR 0.49, 95% CI:0.16-1.56; I2=70%) and major bleeding (HR 1.68, 95%CI:0.59-4.77; I2=97%).
Conclusions
Our results show that rivaroxaban and warfarin have comparable efficacy and bleeding risks in patients with AF and VHD.