Net clinical benefit of rivaroxaban compared with warfarin in atrial fibrillation: Results from ROCKET AF.


Journal Article

AIMS: The aim of this study was to determine the net clinical benefit (NCB) of rivaroxaban compared with warfarin in patients with atrial fibrillation. METHODS: This was a retrospective analysis of 14,236 patients included in ROCKET AF who received at least one dose of study drug. We analyzed NCB using four different methods: (1) composite of death, stroke, systemic embolism, myocardial infarction, and major bleeding; (2) method 1 with fatal or critical organ bleeding substituted for major bleeding; (3) difference between the rate of ischemic stroke or systemic embolism minus 1.5 times the difference between the rate of intracranial hemorrhage; and (4) weighted sum of differences between rates of death, ischemic stroke or systemic embolism, intracranial hemorrhage, and major bleeding. RESULTS: Rivaroxaban was associated with a lower risk of the composite outcome of death, myocardial infarction, stroke, or systemic embolism (rate difference per 10,000 patient-years [RD]=-86.8 [95% CI -143.6 to -30.0]) and fatal or critical organ bleeding (-41.3 [-68 to -14.7]). However, rivaroxaban was associated with a higher risk of major bleeding other than fatal or critical organ bleeding (55.9 [14.7 to 97.2]). Method 1 showed no difference between treatments (-35.5 [-108.4 to 37.3]). Methods 2-4 favored treatment with rivaroxaban (2: -96.8 [-157.0 to -36.8]; 3: -65.2 [-112.3 to -17.8]; 4: -54.8 [-96.0 to -10.2]). CONCLUSIONS: Rivaroxaban was associated with favorable NCB compared with warfarin. The NCB was attributable to lower rates of ischemic events and fatal or critical organ bleeding.

Full Text

Duke Authors

Cited Authors

  • Barnett, AS; Cyr, DD; Goodman, SG; Levitan, BS; Yuan, Z; Hankey, GJ; Singer, DE; Becker, RC; Breithardt, G; Berkowitz, SD; Halperin, JL; Hacke, W; Mahaffey, KW; Nessel, CC; Fox, KAA; Patel, MR; Piccini, JP

Published Date

  • April 15, 2018

Published In

Volume / Issue

  • 257 /

Start / End Page

  • 78 - 83

PubMed ID

  • 29506743

Pubmed Central ID

  • 29506743

Electronic International Standard Serial Number (EISSN)

  • 1874-1754

Digital Object Identifier (DOI)

  • 10.1016/j.ijcard.2017.06.110


  • eng

Conference Location

  • Netherlands