Atrial fibrillation (AF), the most common form of
cardiac arrhythmia, is a major risk factor for
cardioembolic stroke. Dose-adjusted
warfarin has been the gold standard for
stroke prophylaxis in moderate- to high-risk patients with AF. However, the use of
warfarin therapy is greatly limited by its narrow therapeutic window, numerous
dietary restrictions, and
drug-drug interactions, and an increased risk of
hemorrhage. As a result, great emphasis has been placed on developing a new
anticoagulant agent with fewer risks and limitations. Current data suggest that the oral
direct factor Xa inhibitor rivaroxaban is a safe and effective alternative to
warfarin. Furthermore,
rivaroxaban does not require routine coagulation monitoring, which may improve patient compliance to
anticoagulant therapy. The ROCKET AF trial demonstrated that 20-mg oral
rivaroxaban taken once daily was noninferior to dose-adjusted
warfarin in the prevention of
stroke and non-central nervous system systemic
embolism and had a comparable risk of
bleeding. Based primarily on the ROCKET AF trial results, the US Food and Drug Administration recently approved the use of
rivaroxaban for
stroke prophylaxis in patients with nonvalvular AF. However, additional postmarketing studies on its safety and cost effectiveness are needed before it can be widely accepted as a sound alternative to
warfarin.