AIM: Anticoagulation prophylaxis for stroke is recommended for at-risk patients 
with either persistent or paroxysmal atrial fibrillation (AF). We compared 
outcomes in patients with persistent vs. paroxysmal AF receiving oral 
anticoagulation.
METHODS AND RESULTS: Patients randomized in the Rivaroxaban Once Daily Oral 
Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of 
Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial (n = 14 264) 
were grouped by baseline AF category: paroxysmal or persistent. Multivariable 
adjustment was performed to compare thrombo-embolic events, bleeding, and death 
between groups, in high-risk subgroups, and across treatment assignment 
(rivaroxaban or warfarin). Of 14 062 patients, 11 548 (82%) had persistent AF 
and 2514 (18%) had paroxysmal AF. Patients with persistent AF were marginally 
older (73 vs. 72, P = 0.03), less likely female (39 vs. 45%, P < 0.0001), and 
more likely to have previously used vitamin K antagonists (64 vs. 56%, P < 
0.0001) compared with patients with paroxysmal AF. In patients randomized to 
warfarin, time in therapeutic range was similar (58 vs. 57%, P = 0.94). Patients 
with persistent AF had higher adjusted rates of stroke or systemic embolism 
(2.18 vs. 1.73 events per 100-patient-years, P = 0.048) and all-cause mortality 
(4.78 vs. 3.52, P = 0.006). Rates of major bleeding were similar (3.55 vs. 3.31, 
P = 0.77). Rates of stroke or systemic embolism in both types of AF did not 
differ by treatment assignment (rivaroxaban vs. warfarin, Pinteraction = 0.6).
CONCLUSION: In patients with AF at moderate-to-high risk of stroke receiving 
anticoagulation, those with persistent AF have a higher risk of thrombo-embolic 
events and worse survival compared with paroxysmal AF.