A Clinical perspective to the role of Rivaroxaban in heart failure patients

Abstract

Background: Assessment of thromboembolic-related hospitalizations in patients with HF demonstrated the lowest prevalence rate per 1000 person-years, but they had a longer length of stay and higher total health care costs, making it the most costly type of hospitalization. Patients with HF have an increased risk of stroke and systemic embolism, particularly in the setting of atrial fibrillation. Conventional anticoagulants are often used to prevent thromboembolism, but these are accompanied by disadvantages. A NOAC (novel oral anticoagulant), rivaroxaban represents a possible option with a more balanced pharmacological profile.

Objective: To evaluate the safety and efficacy of rivaroxaban for thromboembolic events in heart failure patients with or without atrial fibrillation (AF), we further assessed the effect of rivaroxaban on hospitalization and mortality rates.

Methods: This study was a prospective observational one, and 180 patients with chronic heart failure from the outpatient department were enrolled in this research. The other 90 patients took daily rivaroxaban (15-20 mg), compared with standard antiplatelet or anticoagulant therapy used in the other half of the group with either aspirin or warfarin, respectively. Outcome assessments were at twelve months of follow-up. Outcomes were rates of stroke, systemic embolism, bleeding events, rehospitalization, and all-cause death.

Results: Rivaroxaban reduced the risk of thromboembolic events more than the control (4.4% vs 9.9%). There were slightly more major bleeding events in the rivaroxaban enrollments (3.3%), albeit not statistically significant. The rivaroxaban group had lower hospital readmissions (16.7% vs 25.6%), and a non-significant trend toward reduced all-cause mortality

Conclusions: Rivaroxaban is a targeted anticoagulant that may prove beneficial and cost-effective in heart failure patients for reducing thromboembolic risk and hospitalization. It might provide a reasonable tradeoff of efficacy and safety, especially among non-valvular AF patients or in those with other reasons for stroke.