Effect of Rivaroxaban in Stroke Prevention in Patient with Atrial Fibrillation due to Valvular Heart Disease

Objective: To observe the effect of rivaroxaban in patients with atrial fibrillation due to valvular heart diseases for proper anticoagulation to avoid stroke. Methodology: An observational follow up study was carried out in Cardiology Department of Aziz Fatimah Hospital, Faisalabad from February to August 2021. The study included 36 patients of valvular heart disease with atrial fibrillation on warfarin, whose INR was not tested during the last 4 months due to lack of facility nearby. All patients with non valvular atrial fibrillation were excluded .All patients were given rivaroxaban to replace warfarin. These patients were followed up for 6 months in the OPD of the same hospital to observe the end points including stroke and bleeding episodes and ischemic changes on ECG.Results: Total of 36 patients of mean age and SD of 56±7.00 years were followed up. Out of which 20 were male and 16 were female subjects.Not a single incident of stroke or bleeding episode or bruises was observed during the 6 month follow up.  On echocardiographic examination, none of the patients showed clot in the left atrium. Left atrium size and LV ejection fraction remained the same, during next visit. LA size 44±5 and 44±6 on 1st and second visit respectively (p value =0.059) No other ischemic changes found in the ECG of any patient. International normalization ratio (INR) mean and SD was  2.1± 0.9, 2.2± 0.8, on 1st and 2nd visit of follow up respectively and no significant difference was noted between INR values.Conclusion: Rivaroxaban can be given safely to the patients with valvular heart disease with atrial fibrillation, particularly in patients who cannot get the INR checked on regular basis.