Letter by Bouatou et al Regarding Article, “Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation”
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To the Editor:
In a post hoc analysis of the ROCKET AF trial (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation), Piccini et al1 reported an increased number of comedications associated with a higher risk of bleeding without differential outcomes in those treated with ≥1 combined CYP3A4 (cytochrome P450 3A4) and P-gp (P-glycoprotein) moderate inhibitors. Despite the package insert warning and precautions for rivaroxaban use with P-gp and CYP3A inhibitors, Piccini et al considered their outcome analysis sufficiently reassuring for clinicians to use rivaroxaban with combined inhibitors. …