Antiplatelets for Cardiovascular Disease in Non-valvular AF with Rivaroxaban: A Subanalysis of the EXPAND Study

DOI Web Site PubMed 23 References
  • Kaikita Koichi
    Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
  • Uchiyama Shinichiro
    Clinical Research Center for Medicine, Center for Brain and Cerebral Vessels, Sanno Medical Center
  • Atarashi Hirotsugu
    Nippon Medical School Tama Nagayama Hospital
  • Inoue Hiroshi
    Saiseikai Toyama Hospital
  • Kitazono Takanari
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Yamashita Takeshi
    Cardiovascular Institute Hospital
  • Shimizu Wataru
    Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
  • Ikeda Takanori
    Department of Cardiovascular Medicine, Toho University Faculty of Medicine
  • Kamouchi Masahiro
    Department of Health Care Administration and Management, Center for Cohort Study, Kyushu University Graduate School of Medical Sciences
  • Fukuda Koji
    Division of Heart Rhythm, International University of Health and Welfare Hospital, International University of Health and Welfare
  • Origasa Hideki
    The Institute of Statistical Mathematics
  • Shimokawa Hiroaki
    Graduate School, International University of Health and Welfare Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine

Description

<p> Aim: In this subanalysis of the EXPAND study, we evaluated the risks and benefits of rivaroxaban plus antiplatelet therapy (APT) for patients with non-valvular atrial fibrillation (NVAF) complicated by stable coronary artery disease (CAD), ischemic stroke, or peripheral artery disease (PAD).</p><p>Methods: From the EXPAND study population (n=7,141), patients with NVAF complicated by stable CAD (n=886), ischemic stroke (n=1,231), or PAD (n=160) were included. Patients complicated by any of them were set as ALL (n=2,030). Patients were all treated with rivaroxaban (10 or 15 mg/day) with (+) or without (−) APT. Efficacy outcomes were symptomatic stroke＋systemic embolism (SE), symptomatic stroke＋SE＋myocardial infarction＋cardiovascular death, and all-cause death. Safety outcomes included major and any bleeding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for differences between the APT(+) and APT(−) groups.</p><p>Results: There were no significant differences in the efficacy outcomes between the APT(+) and APT(−) groups in the ALL cohort or in the CAD and STROKE sub-cohorts. In the PAD subcohort, the HR [95% CI] for all-cause death in the APT(+) group increased (4.43 [1.05–18.71]; p=0.043). In the APT(+) group, the HR [95% CI] for any bleeding increased in the ALL cohort (1.28 [1.01–1.62]; p=0.044) and STROKE subcohort (1.42 [1.01–2.01]; p=0.047), and for major bleeding in the CAD subcohort (2.00 [1.01–3.93]; p=0.046).</p><p>Conclusions: Rivaroxaban with APT did not reduce ischemic outcomes in patients with stable CAD or ischemic stroke; however, it did increase the risk of bleeding in patients with stable CAD or ischemic stroke.</p>

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