New analysis from the AFIRE trial suggests rivaroxaban monotherapy might be emerging as a preferred antithrombotic strategy for patients with AFib and stable coronary artery disease, especially in older age groups.
- Rivaroxaban (Bayer/J&J’s Xarelto) is a direct oral anticoagulant that inhibits Factor Xa, preventing blood clot formation.
- Current practice in AFib patients with CAD often combines rivaroxaban with antiplatelet therapy, but this increases bleeding risk.
The Post Hoc AFIRE Analysis examined 2,215 Japanese patients with AFib and stable CAD, stratifying them into four age groups (<70, 70-74, 75-79, and ≥80 years) to compare rivaroxaban monotherapy against rivaroxaban plus antiplatelet therapy over 3.5 years, and found that…
- Rivaroxaban monotherapy reduced major CV events across all age groups, with the most pronounced benefit in patients ≥80 years (6.2% vs 10.3% event rate).
- Bleeding safety advantages were highest in younger patients (<70 years), where monotherapy reduced major bleeding from 2.3% to 0.5%.
- No significant adverse effects were found across the age groups, suggesting stable benefits regardless of patient age.
These findings challenge the current paradigm of dual antithrombotic therapy in this high-risk population since the current status quo is adding antiplatelet therapy to anticoagulation.
- If validated, the results could help shift treatment guidelines to a simpler monotherapy for the estimated 2.7M Americans with both AFib and CAD.
- The results also add to growing evidence supporting anticoagulation monotherapy strategies, joining recent data from other DOAC trials, which have found monotherapy to be just as effective if not better.
The Takeaway
While only a post-hoc analysis, this study suggests that rivaroxaban monotherapy could offer consistent clinical benefits across age groups in AFib patients with stable CAD, however we’ll have to see more direct research to back up these preliminary findings.
