ROCKET AF sub study on rivaroxaban in elderly

ROCKET AF sub study on rivaroxaban in elderly

Journal Review

ROCKET AF sub study on rivaroxaban in elderly evaluated this oral factor Xa inhibitor. It has been shown to be non inferior to warfarin in the ROCKET AF trial. A sub study evaluated how it fared in the elderly [1].

Over six thousand and two hundred patients with nonvalvular atrial fibrillation, aged seventy five or more and having two more more stroke risk factors were evaluated in the sub study. Dose of rivaroxaban used was 20 milligrams daily, which was lowered to 15 mg daily if the creatinine clearance was lower than fifty milliliters per minute. It was a double blind study and the primary endpoints were systemic embolism and stroke. The analysis was conducted on an intention to treat basis.

The elderly group which constituted forty four percent of the whole study group had similar advantages with rivaroxaban over warfarin, but had higher event rates – both stroke and bleeding, than younger individuals, as expected. But hemorrhagic strokes were similar in both groups. Hence the authors support the use of rivaroxaban as a viable alternative in the elderly. As warfarin has a lot of drug – drug and drug – food interactions, if safety of rivaroxaban in elderly, a good number of elderly with atrial fibrillation who are not on warfarin because of fears of bleeding may get the benefit of anticoagulation from this new drug. Moreover this drug does not need regular monitoring of anticoagulation like warfarin.

Reference

1. Halperin JL, Hankey GJ, Wojdyla DM, Piccini JP, Lokhnygina Y, Patel MR, Breithardt G, Singer DE, Becker RC, Hacke W, Paolini JF, Nessel CC, Mahaffey KW, Califf RM, Fox KA; ROCKET AF Steering Committee and Investigators. Efficacy and Safety of Rivaroxaban Compared With Warfarin Among Elderly Patients With Nonvalvular Atrial Fibrillation in 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). Circulation. 2014; 130: 138-146