Chonnam Med J.  2019 Jan;55(1):54-61. 10.4068/cmj.2019.55.1.54.

Real World Comparison of Rivaroxaban and Warfarin in Korean Patients with Atrial Fibrillation: Propensity Matching Cohort Analysis

• Jeong HK
• Lee KH
• Park HW
• Yoon NS
• Kim MC
• Lee N
• Kim JS
• Ahn Y
• Jeong MH
• Park JC
• Cho JG

• KMID: 2432256
• DOI: http://doi.org/10.4068/cmj.2019.55.1.54

Abstract

Rivaroxaban has emerged as a potential alternative to warfarin for the prevention of thromboembolism in patients with atrial fibrillation (AF). However, there has been concern for the risk of major bleeding, especially in Asian patients. We investigated the efficacy and safety of rivaroxaban compared to warfarin in Korean real world practice. A total of 2,208 consecutive non-valvular AF patients were divided into the Warfarin group (n=990) and the Rivaroxaban group (n=1218). Propensity matched 1-year clinical outcomes were compared (Warfarin, n=804; Rivaroxaban, n=804). The efficacy outcome was defined as stroke/systemic embolism (SE). The safety outcome was major bleeding. The primary net clinical benefit (NCB) was defined as the composite of stroke/SE, major bleeding, and all-cause mortality. Secondary, NCB was defined as the composite of stroke, SE, and major bleeding. Rivaroxaban had the similar efficacy in terms of thromboembolic event prevention [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.37-1.32, p=0.266] compared to warfarin. Rivaroxaban significantly lowered the risk of major bleeding [HR 0.41, 95% CI 0.22-0.76, p=0.004]. Primary NCB was significantly low in the rivaroxaban group [HR 0.54, 95% CI 0.36-0.81, p=0.003]. Secondary NCB was also low in the rivaroxaban group [HR 0.62, 95% CI 0.40-0.99, p=0.041]. Both rivaroxaban 15 mg and 20 mg groups had similar efficacy and significantly lower risks of major bleeding as well as primary and secondary NCB compared to the warfarin group. In patients with non-valvular AF, rivaroxaban had a similar efficacy to warfarin in Korean real world practice. However, rivaroxaban had better safety and net clinical outcomes compared to warfarin.

Keyword

Atrial Fibrillation; Rivaroxaban; Warfarin; Thromboembolism; Hemorrhage

MeSH Terms

Asian Continental Ancestry Group
Atrial Fibrillation*
Cohort Studies*
Embolism
Hemorrhage
Humans
Mortality
Rivaroxaban*
Stroke
Thromboembolism
Warfarin*
Rivaroxaban
Warfarin

Figure

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  FIG. 1 (A) Kaplan-Meier estimation for stroke/systemic embolism between patients with warfarin and rivaroxaban, (B) Kaplan-Meier estimation for major bleeding between patients with warfarin and rivaroxaban.

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  FIG. 2 (A) Kaplan-Meier estimation for primary net clinical benefit between patients with warfarin and rivaroxaban, (B) Kaplan-Meier estimation for secondary net clinical benefit between patients with warfarin and rivaroxaban.

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