Atrial fibrillation or AF is a heart condition characterized by irregular heart rhythms, which increases the risk of stroke caused by blood clots by five-fold. According to a 2015 study published on National Center for Biotechnology Information’s website, strokes due to AF are more severe, causing disability in over 50 percent of patients.
It is one of the leading causes of severe strokes in Asia. The Department of Health said diseases of the vascular system, including stroke, which is a complication of non-valvular atrial fibrillation, is the second leading cause of mortality in the Philippines, after diseases of the heart. AF occurs in 2 percent of Filipinos above 70 years old based on a national survey conducted by the DOH and the Food and Nutrition Research Institute.
The prevalence of AF increases with age, hence it is a growing concern in Asia due to the region’s rapidly aging population. It is estimated that in 2050, Asia will have 72 million AF patients, and 2.9 million of them will suffer from an AF-associated stroke.
A recent real-world study on the Prevention of Stroke in Patients with AF in Asia followed 2,273 Asian patients from 435 sites across Hong Kong SAR, Indonesia, South Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam, and Pakistan in routine clinical practice.
Elderly patients, with an average age of 70.5 years old, were observed. The participants have varying levels of stroke risk, with significant medical co-morbidities including heart failure, hypertension, diabetes mellitus, prior stroke/systemic embolism/transient ischemic attack, and myocardial infarction.
The study showed AF-related strokes can be prevented. Good results of a low bleeding rate of 1.5 percent per year and low stroke rate of 1.7 percent per year were recorded in AF patients treated with non-vitamin K antagonist oral anticoagulant (NOAC) Rivaroxaban.
Over 96 percent of patients treated with Rivaroxaban in the study did not experience any major bleeding, stroke/systemic embolism, or all-cause death, thereby reinforcing the safety and efficacy of Rivaroxaban among unselected patients in the real world.
This was despite the underlying fact that based on epidemiologic studies, having an Asian ethnicity has been associated with both a higher risk for stroke and intracranial hemorrhage/bleeding.
However, there is still a significant number of AF patients in Asia not receiving optimal anticoagulant therapy for stroke prevention.
“While NOACs offer a new standard of care in preventing AF-related strokes, major bleeding is a key consideration of doctors when prescribing NOACs for AF patients. This data confirm the low bleeding risk of Rivaroxaban in Asian patients, thus reaffirming its positive benefit/risk profile, and demonstrate its value in preventing the negative impact of stroke on patients and society,” said XANAP principal investigator, Professor Young-Hoon Kim of Korea University Medical Centre.
NOACs like Rivaroxaban (Xarelto) match Warfarin in stroke prevention, but are easier to administer and significantly reduce the risk of life-threatening bleeding, particularly skull bleeding. Regular tweaking is not required and dietary restrictions and interactions with other substances are few and insignificant.
Anticoagulant medicines are potent therapies used to prevent or treat serious illnesses and potentially life-threatening conditions. Before initiating therapy with anticoagulant medicines, physicians should carefully assess the benefit and risk for the individual patient.
“It is important to consider a patient’s individual risk factors to prescribe the right NOAC to the right patient for AF stroke prevention,” noted Professor Chia-Ti Tsai of National Taiwan University Hospital, another XANAP principal investigator.
Tsai continued, “Rivaroxaban’s robust experience and evidence in patients across different risk profiles, including those with high stroke risk, will best support doctors and patients in their treatment decision in AF management. The positive data of XANAP further add to this and reaffirm the proven safety profile of Rivaroxaban in Asian patients.”
Responsible use of Rivaroxaban (Xarelto) is a very high priority for Bayer, and the company has developed a Prescribers Guide for physicians and a Rivaroxaban (Xarelto) Patient Card for patients to support best practice.”‹