Commentary to the article: “Rivaroxaban in secondary cardiogenic stroke prevention: two-year single-centre experience based on follow-up of 209 patients”

It is known that a history of stroke or transient ischaemic attack (TIA) is a major risk factor for recurrent ischaemic events as well as bleeding in atrial fibrillation (AF), so effective anticoagulation is of key importance in this high-risk subgroup.Therefore, I read with interest the paper by Lasek-Bal et al. [1].The authors presented an observational study on Polish patients with AF and previous stroke or TIA, who were treated with rivaroxaban and followed-up for 24 months.The results support the use of rivaroxaban for prevention of recurrent stroke in patients with AF.There are still few studies confronting the current data obtained in Polish clinics with a rapidly growing number of international registries or those from Western European countries.A subgroup analysis of the ROCKET-AF study demonstrated that the efficacy and safety of rivaroxaban compared with warfarin did not differ among AF patients with or without previous stroke or TIA [2].Unfortunately, the current study did not include a prospective or historic control group on vitamin K antagonists.It remains to established whether also in Poland rivaroxaban versus warfarin or acenocoumarol are similarly effective and safe when administered to real-life patients with nonvalvular AF.The authors focused on bleeding complications during follow-up and showed a rather low rate of these events (less than 1%, n = 2).Piccini et al. [3] reported in the ROCKET-AF study (with as many as 52% of AF patients following cerebrovascular events) that during a median follow-up of 1.9 years 5.5% of patients experienced major bleeding.Surprisingly, epistaxis was common in this group (6.2%), while in the ROCKET-AF group 3.2% of the patients on rivaroxaban experienced this complication in contrast to about 50% of the bleeding patients who had upper or lower gastrointestinal tract bleeding (one case of a total of 25 in the present study) [3].The