Introduction This X-VeRT (eXplore the efficacy and safety of once-daily oral
riVaroxaban for the prevention of caRdiovascular events in patients with nonvalvular
aTrial fibrillation scheduled for
cardioversion) substudy evaluated the effects of treatment with
rivaroxaban or a
vitamin-K antagonist (VKA) on levels of
biomarkers of coagulation (
D-dimer,
thrombin-antithrombin III complex [TAT] and
prothrombin fragment [F1.2]) and
inflammation (
high sensitivity C-reactive protein [
hs-CRP] and high-sensitivity
interleukin-6 [hs-IL-6]) in patients with
atrial fibrillation (AF) who were scheduled for
cardioversion and had not received adequate anticoagulation at baseline (defined as, in the 21 days before randomization: no oral
anticoagulant; international normalized ratio <2.0 with VKA treatment; or <80% compliance with non-VKA oral
anticoagulant treatment). Methods Samples for
biomarker analysis were taken at baseline ( n = 958) and treatment completion (42 days after
cardioversion; n = 918). The influence of clinical characteristics on baseline
biomarker levels and the effect of treatment on changes in
biomarker levels were evaluated using linear and logistic models. Results Baseline levels of some
biomarkers were significantly associated with type of AF (D-dimer and hs-IL-6) and with history of
congestive heart failure (hs-CRP, D-dimer, and hs-IL-6).
Rivaroxaban and VKA treatments were associated with reductions from baseline in levels of
D-dimer (-32.3 and -37.6%, respectively), TAT (-28.0 and -23.1%, respectively),
hs-CRP (-12.5 and -17.9%, respectively), and hs-IL-6 (-9.2 and -9.8%, respectively). F1.2 levels were reduced from baseline in patients receiving a VKA (-53.0%) but not in those receiving
rivaroxaban (2.7%). Conclusion Anticoagulation with
rivaroxaban reduced levels of key
inflammation and coagulation
biomarkers to a similar extent as VKAs, with the exception of F1.2. Further investigation to confirm the value of these
biomarkers in patients with AF is merited.