Rivaroxaban in Patients With Atrial Fibrillation Who Underwent Percutaneous Coronary Intervention in Clinical Practice

• Published in: The American journal of cardiology Vol. 189; pp. 31 - 37
• Main Authors: Zeymer, Uwe, Toelg, Ralph, Wienbergen, Harm, Hobbach, Hans-Peter, Cuneo, Alessandro, Bekeredjian, Raffi, Ritter, Oliver, Hailer, Birgit, Hertting, Klaus, Hennersdorf, Marcus, Scholtz, Werner, Lanzer, Peter, Mudra, Harald, Schwefer, Markus, Schwimmbeck, Peter-Lothar, Liebetrau, Christoph, Thiele, Holger, Claas, Christoph, Riemer, Thomas, Zahn, Ralf
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-02-2023; Elsevier Limited
• Subjects: Acute coronary syndromes; Angioplasty; Anticoagulants; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Bleeding; Cardiac arrhythmia; Cardiovascular disease; Cerebral infarction; Clinical medicine; Consortia; Drug Therapy, Combination; Fibrillation; Fibrinolytic Agents - therapeutic use; Heart attacks; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Implants; Ischemia; Myocardial infarction; Observational studies; Participation; Patients; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Rivaroxaban; Stroke; Thromboembolism; Thrombosis; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2022.11.009

Little is known about the efficacy and safety of rivaroxaban in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) in clinical practice. We therefore conducted a prospective observational study to determine the rate of ischemic, embolic, and bleeding events in patients with AF and PCI treated with rivaroxaban in a real-world experience. The RIVA-PCI (“rivaroxaban in patients with AF who underwent PCI”) (clinicaltrials.gov NCT03315650) is a prospective, noninterventional, multicenter study with a follow-up until 14 months, including patients with AF who underwent PCI discharged with rivaroxaban. Between January 2018 and March 2020, 700 patients with PCI treated with rivaroxaban (elective in 50.1%, non-ST-elevation acute coronary syndrome 43.0%, ST-elevation myocardial infarction in 6.9%) were enrolled at 51 German hospitals. After PCI, a dual antithrombotic therapy consisting of rivaroxaban and a P2Y12 inhibitor was administered in 70.7% and triple antithrombotic therapy in 27.9%, respectively. Follow-up information could be obtained in 695 patients (99.3%). Rivaroxaban has been stopped prematurely in 21.6% of patients. Clinical events under rivaroxaban during the 14-month follow-up compared with those observed in the PIONEER-AF PCI trial included cardiovascular death (2.0% % vs 2.0%), myocardial infarction (0.9% vs 3.0%), stent thrombosis (0.2% vs 0.8%), stroke (1.3% vs 1.3%), International Society on Thrombosis and Haemostasis major (4.2% vs 3.9%), and International Society on Thrombosis and Haemostasis nonmajor clinically relevant bleeding (15.3% vs 12.9%). Therefore, in this real-world experience, rivaroxaban in patients with AF who underwent PCI is associated with ischemic and bleeding event rates comparable with those observed in the randomized PIONEER-AF PCI trial.