Blood clots can travel great distances in your body and cause a stroke. This type of stroke is called an embolic stroke. And sometimes doctors can’t find the source of the original clot. As a result, patients who had this type of stroke tend to suffer more from recurrent strokes. Aspirin is the standard medication to reduce embolic stroke risk. It works by blocking platelets from clotting in our blood. But now that we have so many strong anticoagulants (medicines that prevent blood clots), out there, are there better drugs to do the job?
Rivaroxaban prevents stroke in people with irregular heartbeat
Doctors hypothesized that other anticoagulants can help prevent recurrent embolic strokes. But can they do a better job than aspirin? Rivaroxaban, sold under the name Xarelto, is one drug that researchers wanted to put to the test. It blocks factor Xa, which is an important protein in blood clotting. We currently use Rivaroxaban to prevent strokes in patients with irregular heartbeat.
Can Rivaroxaban prevent stroke?
Can Rivaroxaban do a better job than aspirin in preventing stroke? Doctors wanted to know if this blood thinner could help patients with higher risk, such as those with embolic stroke with an undetermined cause. Their important findings were recently published in the well-respected journal, New England Journal of Medicine. Doctors from all over the world recruited 7213 patients at 459 sites. Eligible patients were over 49 years old and recovering from a recent ischemic stroke. Only those who had embolic strokes without a clear source were included.
Doctors randomly selected half of their participants to receive Rivaroxaban, which was given at 15mg daily. The rest of their patients got standard aspirin therapy. Patients were then followed at 1 month, 6 months, 12 months, and every 6 months thereafter. They recorded strokes, heart attacks, death, and the blood clots during this follow up period. Researchers also monitored patients for safety measures such as bleeding.
It turns out that Rivaroxaban wasn’t better after all. Both aspirin and Rivaroxaban groups had a 5% risk of getting a stroke. But an unexpected turn of events had to cut the study short. Life-threatening bleeding was more common than anticipated, so the study ended early to keep patients safe. During the 11 months of the study, 1.8% of patients suffered major bleeding from Rivaroxaban compared to 0.7% of the aspirin group. Patients on Rivaroxaban were almost 3 times more likely to experience life-threatening bleeding during this study.
There’s simply too much risk
Authors concluded that Rivaroxaban was not better than aspirin in preventing recurrent embolic strokes with an undetermined cause. In fact, it put patients at higher risks compared to standard therapy today. Rivaroxaban caused more bleeding than aspirin therapy without any additional benefit.
The future of stroke prevention
Unless you suffer from an irregular heartbeat, it’s best to stick with aspirin for stroke prevention. However, it’s important to note that other blood thinners are still in the running. Currently, ongoing clinical trials are looking at other anticoagulants for stroke prevention. Even though Rivaroxaban failed the test, it doesn’t mean another agent couldn’t work better.
The lead author of this study was Dr. Robert G Hart, Population Health Research Institute, David Braley Cardiac, Vascular, and Stroke Research Institute, in Ontario, Canada.