Rivaroxaban or Warfarin in Atrial Fibrillation With OSA

According to a study, obstructive sleep apnea (OSA) is associated with increased incidences of atrial fibrillation and other adverse cardiovascular events. Researchers, led by Nitesh Sood, compared rivaroxaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and concomitant OSA.

The investigators found rivaroxaban showed a similar risk for stroke or systemic embolism (SSE) compared with warfarin; however, rivaroxaban was associated with fewer intra- and extracranial bleeding-related hospitalizations. The findings were published in TH Open.

Additional Benefits With Rivaroxaban Versus Warfarin

Researchers analyzed electronic health records total of 21940 patients on rivaroxaban and 38213 on warfarin from November 2010 to December 2021. All patients had NVAF and OSA and initiated first-time rivaroxaban or warfarin at enrollment. The primary end points were incidence of SSE and bleeding-related hospitalization.

Rivaroxaban had a similar risk of SSE compared with warfarin (hazard ratio [HR], 0.92; 95% CI, 0.82-1.03) among patients with NVAF and OSA. Notably, rivaroxaban provided additional benefits with reductions in any bleeding-related hospitalizations (HR, 0.85; 95% CI, 0.78-0.92), intracranial bleeding (HR, 0.76; 95% CI, 0.62-0.94), and extracranial bleeding (HR, 0.89; 95% CI, 0.81-0.97).

Authors conducted a sensitivity analysis on just patients with prespecified CHA2DS2VASc scores and estimated reductions of 33% and 43% in risks for SSE and bleeding-related hospitalizations, respectively. Investigators found no differences between subgroups.

Ultimately, “these data should provide prescribers with additional confidence in selecting rivaroxaban in NVAF patients who have OSA at the time of anticoagulation initiation,” the authors closed.

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