Rivaroxaban administration after acute ischemic stroke: The RELAXED study

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Efficacy of early anticoagulation in acute stroke with nonvalvular atrial fibrillation (NVAF) is unclear.
• Risk of recurrent ischemic stroke (IS) and major bleeding needs evaluation.

Purpose of the Study:

• Evaluate the risk of recurrent IS and major bleeding in acute IS patients with NVAF treated with rivaroxaban.
• Assess the relationship between time to rivaroxaban initiation and outcomes.

Main Methods:

• Observational study of NVAF patients with acute IS/TIA in the middle cerebral arterial territory.
• Rivaroxaban initiated within 30 days of index IS/TIA.
• Primary endpoints: recurrent IS and major bleeding within 90 days.
• Correlation analysis using infarct volume (diffusion-weighted MRI) and time to treatment.

Main Results:

• 1309 patients analyzed: 2.3% recurrent IS, 0.8% major bleeding.
• Recurrent IS less frequent when rivaroxaban started ≤14 days vs. ≥15 days (2.0% vs. 6.8%, P=0.0034).
• For those starting rivaroxaban <3 days (N=584), recurrent IS was 1.5% and major bleeding 0.7%.

Conclusions:

• Initiating rivaroxaban in acute IS/TIA patients with NVAF is feasible, showing low 90-day recurrence (2.3%) and bleeding (0.8%) rates.
• Starting rivaroxaban within 14 days of IS is feasible for preventing recurrent attacks.
• Early rivaroxaban initiation (within 3 days) may be a viable option for patients with small or medium infarcts.