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Nov 07, 2014

Study Identifies Increased Bleeding Risk in Certain AFib Patients

Blood thinners may carry increased bleeding risk for patients that meet criteria for non-valvular atrial fibrillation, but have underlying valve disease.

While blood thinners carry increased bleeding risk for certain patients with valve disease and atrial fibrillation, rivaroxaban and warfarin are comparable in reducing stroke, according to a study recently published in the European Heart Journal.

Known as the ROCKET AF trial, this study compared the use of two blood thinners, rivaroxaban (brand: Xarelto) and warfarin (brand: Coumadin, Jantoven), for stroke prevention in patients with atrial fibrillation. Atrial fibrillation, the most common type of abnormal heart rhythm, drastically increases risk of stroke and most patients with AFib take blood thinners to reduce risk of life-threatening complications. And with the introduction of novel blood thinners like rivaroxaban, experts question their safety and efficacy compared to warfarin—the most widely used blood thinner, which was approved by the FDA in the 1950s.

Previous analysis of the ROCKET AF trial suggests that rivaroxaban is, in fact, as safe and effective as warfarin in patients with non-valvular AFib. However, experts wondered if outcomes are any different in AFib patients with significant valvular disease. Although the ROCKET AF trial included only patients with non-valvular AFib, some patients with specific types of valvular disease were eligible for the study.

After analyzing results of the ROCKET AF trial, researchers found that 14% of the 14,171 study participants had some form of significant valve disease. In these patients, rivaroxaban and warfarin worked just as well as in preventing stroke as they did in patients with non-valvular afib. However, risk of bleeding was significantly higher in patients with valve disease taking either blood thinner compared to those without valvular disease.

The good news is that both rivaroxaban and warfarin appear to work just as well in preventing stroke in AFib patients with valve disease compared to those with non-valvular AFib. However, given the possible increased risk of bleeding associated with these blood thinners, authors believe that doctors should be cautious when prescribing blood thinners to certain AFib patients with valvular disease. As authors argue, it’s important that doctors are aware of increased bleeding risks and use caution when prescribing blood thinners to patients with atrial fibrillation and valvular heart disease.

Questions for You to Consider

  • What is atrial fibrillation?

  • Atrial fibrillation is an irregular heart rhythm caused by abnormal, chaotic electrical impulses in the heart’s upper chambers, the atria. These electrical impulses, which interfere with the heart’s natural pacemaker, fire so rapidly the atria cannot beat with a regular rhythm or squeeze out blood effectively. Instead, they merely quiver while the ventricles, the heart’s lower chambers, beat rapidly.


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AFib affects more than 3 million people in the United States.