• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Rivaroxaban noninferior to warfarin in patients with atrial fibrillation and bioprosthetic mitral valves

byThomas SuandDeepti Shroff Karhade
November 29, 2020
in Cardiology, Chronic Disease, Surgery
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Patients who received rivaroxaban had a statistically significantly longer mean time until occurrence of a major clinical event compared to those who received warfarin.

2. The incidence of secondary-outcome events such as transient ischemic attack (TIA), valve thrombosis, and non-CNS embolism were similar between groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Atrial fibrillation is associated with an elevated risk of thromboembolic events that is dramatically exacerbated by the presence of valvular heart disease (VHD). Prophylactic anticoagulant therapy is essential for these individuals, but current recommendations are not easily applicable to this patient population due to their exclusion from participation in several pivotal direct oral anticoagulant (DOAC) versus warfarin trials (i.e. Re-LY, AVERROES, ROCKET-AF). To address this insufficiency of direct evidence, this study specifically investigated the prophylactic effect of rivaroxaban in patients with both atrial fibrillation and a bioprosthetic mitral valve, finding that those who received the DOAC had a significantly longer mean time until a major clinical event compared to those who received warfarin. This effect was consistent across most subgroups, but it was pronounced among patients who were enrolled within 3 months of mitral-valve surgery. In the component breakdown, those who received rivaroxaban had a numerically higher, but not statistically significant, incidence of valve thrombosis versus warfarin at 1 year and a lower incidence of other secondary outcomes such as stroke and death from cardiovascular causes or thromboembolic events. The total number of bleeding events was similar between the two groups, but individual events were generally of lesser severity among those who received rivaroxaban. While these findings cannot be generalized to patients with other types of valvular heart disease, they suggest that rivaroxaban is noninferior to warfarin for thromboembolism prophylaxis in patients with both atrial fibrillation and a bioprosthetic mitral valve.

Click here to read the study in NEJM

Relevant Reading: Usefulness and Safety of Rivaroxaban in Patients Following Isolated Mitral Valve Replacement With a Mechanical Prosthesis

In-Depth [randomized controlled trial]: In this multicenter study conducted in Brazil from April 2016 through July 2019, 1005 adults who had atrial fibrillation or flutter and a mitral valve prosthesis and were taking or planning on taking oral anticoagulants for thromboembolism prophylaxis were randomly assigned in a 1:1 ratio to receive either rivaroxaban or warfarin. Rivaroxaban was administered at a dosage of 20 mg per day with the exception of patients with a creatinine clearance of 30-49 mL per minute per 1.73 m2 of body-surface area, who instead received 15 mg per day; warfarin dosage was adjusted at least every 4 weeks to maintain a target international normalized ratio (INR) of 2.0 to 3.0. The primary outcome was a composite of death, major bleeding, and major cardiovascular events (stroke, TIA, valve thrombosis, systemic embolism unrelated to the central nervous system, or hospitalization for heart failure). The mean time until any of these events was slightly higher in the rivaroxaban group compared to warfarin (347.5 days vs. 340.1 days; restricted mean survival time difference, 7.4 days; 95% CI, −1.4 to 16.3; P<0.001 for noninferiority and P=0.10 for superiority). Of the individual components of the composite outcome, valve thrombosis was numerically more frequent in the rivaroxaban group (5 vs. 3), while death from cardiovascular causes or thromboembolic events was slightly more frequent in the warfarin group (3.4% vs 5.1%; hazard ratio [HR], 0.65; 95% CI, 0.35 to 1.20). With the exception of stroke (0.6% vs. 2.4%; HR, 0.25; 95% CI, 0.07 to 0.88), other secondary outcomes were similar between groups at 12 months. Serious adverse events (5.8% vs. 6.9%) and total bleeding events (HR, 0.83; 95% CI, 0.59–1.15) occurred at similar rates in both groups, although the warfarin group had a numerically greater number of major, intracranial, and fatal bleeding incidents.

RELATED REPORTS

TRAPS: Rivaroxaban vs. Warfarin for Secondary Prevention in Antiphospholipid Syndrome [Classics Series]

Magnetic resonance imaging-guided fibrosis ablation plus pulmonary vein isolation non-superior to pulmonary vein isolation alone in preventing atrial arrhythmia recurrence: The DECAAF II trial

ANNEXA-A and ANNEXA-R trials: Andaxanet Alfa for Reversal of Apixaban and Rivaroxaban [Classics Series]

Image: PD

©2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: atrial fibrillationbioprosthetic mitral valverivaroxabanwarfarin
Previous Post

Mass distribution of azithromycin shown to increase antibiotic resistance

Next Post

2 Minute Medicine Rewind November 30, 2020

RelatedReports

The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Critical, Emergent and Pulmonary Care Classics

TRAPS: Rivaroxaban vs. Warfarin for Secondary Prevention in Antiphospholipid Syndrome [Classics Series]

June 23, 2022
Rivaroxaban likely reduces risk of recurrent stroke in specific subgroup of patients with embolic stroke of undetermined source
Cardiology

Magnetic resonance imaging-guided fibrosis ablation plus pulmonary vein isolation non-superior to pulmonary vein isolation alone in preventing atrial arrhythmia recurrence: The DECAAF II trial

June 22, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Critical, Emergent and Pulmonary Care Classics

ANNEXA-A and ANNEXA-R trials: Andaxanet Alfa for Reversal of Apixaban and Rivaroxaban [Classics Series]

June 21, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Cardiology Classics

The EAST-AFNET 4 trial: Early rhythm control therapy for atrial fibrillation [Classics Series]

June 13, 2022
Next Post
Survival greater in cervical cancer patients undergoing abdominal hysterectomy compared to minimally invasive techniques: the LACC trial

2 Minute Medicine Rewind November 30, 2020

Comparison of laparoscopic percutaneous extraperitoneal closure and laparoscopic intracorporeal suture in pediatric hernia repair

#VisualAbstract: Effectiveness of lorlatinib in advanced anaplastic lymphoma kinase-positive lung cancer

#VisualAbstract: Effectiveness of lorlatinib in advanced anaplastic lymphoma kinase-positive lung cancer

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Intravenous fluid restriction does not improve septic shock outcomes
  • Intravenous vitamin C increases mortality and organ dysfunction in sepsis patients
  • Magnetic resonance based preoperative evaluation for perianal fistulas superior to traditional clinical method and improve surgical outcomes [Classics Series]
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.