Abstract
With improved life expectancy and the aging population, the global burden of atrial
fibrillation (AF) continues to increase, and with AF comes an estimated fivefold increased
risk of ischaemic stroke. Prophylactic anticoagulant therapy is more effective in
reducing the risk of ischaemic stroke in AF patients than acetylsalicylic acid or
dual-antiplatelet therapy combining ASA with clopidogrel. Non-vitamin K antagonist
oral anticoagulants are the standard of care for stroke prevention in patients with
non-valvular AF. The optimal anticoagulant strategy to prevent thromboembolism in
AF patients who are undergoing percutaneous coronary intervention and stenting, those
who have undergone successful transcatheter aortic valve replacement and those with
embolic stroke of undetermined source are areas of ongoing research. This article
provides an update on three randomized controlled trials of rivaroxaban, a direct,
oral factor Xa inhibitor, that are complete or are ongoing, in these unmet areas of
stroke prevention: oPen-label, randomized, controlled, multicentre study explorIng
twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist
treatment strategy in patients with Atrial Fibrillation who undergo Percutaneous Coronary
Intervention (PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor
Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined
Source (NAVIGATE ESUS) trial and the Global study comparing a rivAroxaban-based antithrombotic
strategy to an antipLatelet-based strategy after transcatheter aortIc vaLve rEplacement
to Optimize clinical outcomes (GALILEO) trial. The data from these studies are anticipated
to help address continuing challenges for a range of patients at risk of stroke.
Keywords
atrial fibrillation - stroke - oral anticoagulant - percutaneous coronary intervention
- transcatheter aortic valve replacement
