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Comparative effectiveness and safety of rivaroxaban and warfarin for stroke prevention in patients with non-valvular atrial fibrillation in an Omani Tertiary Care Hospital.

Al-Maawali, Maya Said; Al-Naamani, Hamed Hilal; Neshat Mokadem, Leila; Al-Maawali, Ghalib; Salman, Bushra; Al-Zakwani, Ibrahim

Authors

Maya Said Al-Maawali

Hamed Hilal Al-Naamani

Ghalib Al-Maawali

Bushra Salman

Ibrahim Al-Zakwani



Abstract

Objective: The aim of the study was to compare the effectiveness and safety of rivaroxaban and warfarin as well as to determine the appropriateness of dosing and prescribing of rivaroxaban in Omani patients with non-valvular atrial fibrillation (NVAF). Methods: This retrospective cohort study was conducted using the Royal Hospital data registry. The study included all adults newly diagnosed with NVAF and treated with rivaroxaban or warfarin. The outcomes measured include ischaemic stroke, gastrointestinal bleeding (GIB), non-gastrointestinal bleeding (NGIB), as well as appropriateness of dosing and prescribing of rivaroxaban. Results: The analysis included 96 rivaroxaban users and 183 warfarin users; 51% of the cohort included males. There were no significant differences observed in the risk of ischaemic stroke between the two groups (hazard ratio (HR), 1.1; 95% confidence interval (CI): 0.4-3.4; p=0.8). However, those on rivaroxaban exhibited a significantly higher rate of GIB compared to those on warfarin (HR, 5.9; 95% CI: 2.9-11.7; p=0.001). There were no differences observed with regards to NGIB between the two groups (HR, 0.9; 95% CI: 0.4-1.9; p=0.8). Dosing and prescribing of rivaroxaban were found to be appropriate in 89% of the patients, with only 6% being prescribed an inappropriately lower dose. Conclusion: The study demonstrated no significant differences in the risk of ischaemic stroke or NGIB between rivaroxaban and warfarin groups in newly diagnosed NVAF patients. However, rivaroxaban users were found to have a significantly higher risk of GIB. Rivaroxaban was appropriately prescribed to the majority of the patients, and only a small proportion of the group received an inappropriately lower dose of rivaroxaban.

Citation

AL-MAAWALI, M.S., AL-NAAMANI, H.H., NESHAT MOKADEM, L., AL-MAAWALI, G., SALMAN, B. and AL-ZAKWANI, I. 2022. Comparative effectiveness and safety of rivaroxaban and warfarin for stroke prevention in patients with non-valvular atrial fibrillation in an Omani Tertiary Care Hospital. Open cardiovascular medicine journal [online], 16, article e187419242202281. Available from: https://doi.org/10.2174/18741924-v16-e2202281

Journal Article Type Article
Acceptance Date Jan 13, 2022
Online Publication Date Jun 20, 2022
Publication Date Dec 31, 2022
Deposit Date Oct 13, 2022
Publicly Available Date Mar 28, 2024
Journal Open Cardiovascular Medicine Journal
Electronic ISSN 1874-1924
Publisher Bentham Open
Peer Reviewed Peer Reviewed
Volume 16
Article Number e187419242202281
DOI https://doi.org/10.2174/18741924-v16-e2202281
Keywords Non-valvular atrial fibrillation; Rivaroxaban; Warfarin; Ischaemic stroke; Gastrointestinal bleeding; Non-gastrointestinal bleeding
Public URL https://rgu-repository.worktribe.com/output/1778013

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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
© 2022 Al-Maawali et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.





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