Rivaroxaban Versus Warfarin in Acute Ischemic Stroke With Atrial Fibrillation
Status:
Completed
Trial end date:
2015-12-01
Target enrollment:
Participant gender:
Summary
Rationale Acute ischemic stroke due to atrial fibrillation (AF) carries a high risk for early
recurrence. In acute stage, guidelines recommend aspirin, but do not recommend
anticoagulation due to the increased risk of intracranial bleeding. Since, aspirin has a
limited efficacy of preventing recurrent stroke in AF, expert consensus suggests early
anticoagulation in non-severe stroke with AF. The current practice for acute ischemic stroke
patients with AF is delayed warfarin administration with aspirin use for non-minor stroke or
immediate warfarin administration (sometimes with heparin bridging) for minor stroke.
However, conventional anticoagulation with warfarin in acute ischemic stroke with AF has the
following limitations: 1) risk of intracranial bleeding particularly in acute stage, 2)
delayed action and transient paradoxical thrombogenic tendency due to the inhibition of
protein C, resulting in the risk of early recurrent embolic stroke, and 3) prolongation of
hospitalization waiting for full anticoagulation. In contrast, as compared to warfarin,
rivaroxaban is advantageous for reduced risk of intracranial bleeding and immediate
anticoagulation efficacy.
Goal The current trial will examine whether early initiation (within 5 days from stroke
onset) of rivaroxaban as compared to conventional warfarin would reduce intracranial
bleeding, recurrent embolic stroke, and hospital stay in patients with acute ischemic stroke
due to AF.