Comparative Effectiveness of Rivaroxaban, Enoxaparin and Aspirin in Patients with Acute Ischemic Stroke
AbstractObjective: To compare effectiveness of Rivaroxaban, Enoxaparin and Aspirin therapy in acute ischemic stroke.
MethodsThis randomized controlled trial in King Edward Medical University, Lahore included 210 patients, aged 18-75 years with acute ischemic stroke within last 24 hours. CT scan brain ruled out any evidence of intracranial bleeding. Functional status was assessed by modified Rankin Score (mRS) at presentation. Patients were randomized to receive 15mg Rivaroxaban, 40mg Enoxaparin twice daily or 300mg aspirin daily for 10 days. Patients were followed up at 14 days for new stroke events and mRS. Absence of major bleed was the safety parameter. Data was analyzed in SPSS 26.0 by ANOVA and chi-square keeping p-value ≤ 0.05 as significant.
Results Among the 53.81% male and 46.19% females (total 210 patients), mean age was 60.44±4.48 years. Mean mRS at day 1 was 3.90±0.422, 3.86±0.460 & 3.81±0.460 in Rivaroxaban, Enoxaparin and Aspirin groups respectively (p-value 0.527). Day 14, mRS was 3.81±0.460, 3.80±0.437 & 3.83±0.450 in the three groups respectively (p-value 0.932). New stroke events in 20 cases and favorable outcomes in 190 were evenly distributed among the 3 groups (p-value 0.488). There was major bleeding event.
Conclusion Anticoagulants (Rivaroxaban or Enoxaparin) are equivalent to Aspirin without increased risk of significant bleeding in the management of patients with acute ischemic stroke.
Keywords:Acute ischemic stroke, Aspirin, Enoxaparain.
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