Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease

Strategic Insights -

Research has been conducted to examine the age-stratified effects of rivaroxaban monotherapy compared with those of rivaroxaban plus antiplatelet agent combination therapy in patients with coronary artery disease (CAD) and atrial fibrillation (AF). The study found that antithrombotic therapy is crucial for older patients with CAD and AF who are at a high risk of bleeding and thrombotic events. The researchers analyzed data from the Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease (AFIRE) open-label randomized clinical trial, which was conducted in Japan from February 23, 2015, to July 31, 2018.

Key Takeaways:

  • Antithrombotic therapy is crucial for older patients with CAD and AF who are at a high risk of bleeding and thrombotic events.
  • The study found possible age-related differences in trends, with more pronounced efficacy in older patients and more pronounced safety in younger patients.
  • Rivaroxaban monotherapy may be an effective treatment option for patients with CAD and AF, particularly among older adults.
  • The study's findings suggest that further research is needed to confirm the age-stratified effects of rivaroxaban monotherapy.
  • The AFIRE randomized clinical trial was a multicenter study conducted in Japan, enrolling patients with AF and stable CAD who had undergone percutaneous coronary intervention or coronary artery bypass grafting 1 or more years earlier.
  • The study's lead author, Hiroyuki Arashi, is a cardiologist at Tokyo Women's Medical University.

Statistics:

  • The study analyzed data from the AFIRE randomized clinical trial, which enrolled 1,596 patients.
  • Patients were stratified into 4 groups by age: younger than 65 years (n = 759), 65-74 years (n = 489), 75-84 years (n = 202), and 85 years or older (n = 46).
  • The study found that the risk of bleeding events was higher in younger patients (4.3% vs. 2.3% in older patients).
  • Rivaroxaban monotherapy was associated with a lower risk of thrombotic events compared with combination therapy among patients aged 75 years or older.
  • The study's findings suggest that the benefits and risks of rivaroxaban monotherapy may vary by age.

Sources:

  • NewsRx. New Findings on Atrial Fibrillation from Tokyo Women's Medical University Summarized (Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE Randomized ...). Cardiovascular Week. August 25, 2025; p 107.
  • Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE Randomized Clinical Trial. JAMA Cardiology, 2025.
  • Hiroyuki Arashi, et al. Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE Randomized Clinical Trial. JAMA Cardiology, 2025.