A prospective, observational study of rivaroxaban for stroke prevention in atrial fibrillation: the XANAP Korea

• Main Authors: Jaemin Shim, Young Keun On, Sun U. Kwon, Gi-Byoung Nam, Moon-Hyoung Lee, Hyung-Wook Park, Keun-Sik Hong, Nam-Ho Kim, Pierre Amarenco, Seung-Woon Rha, Dong-Gu Shin, Joung-Ho Rha, Young-Hoon Kim
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2021-07-01
• Series: The Korean Journal of Internal Medicine
• Subjects: atrial fibrillation; korea; rivaroxaban; stroke
• Online Access: http://www.kjim.org/upload/pdf/kjim-2020-217.pdf
• ISSN: 1226-3303; 2005-6648

Background/Aims Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. Methods This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. Results A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. Conclusions This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE.