Rivaroxaban in Rheumatic Heart Disease–Associated Atrial Fibrillation

Autor: Stuart J, Connolly, Ganesan, Karthikeyan, Mpiko, Ntsekhe, Abraham, Haileamlak, Ahmed, El Sayed, Alaa, El Ghamrawy, Albertino, Damasceno, Alvaro, Avezum, Antonio M L, Dans, Bernard, Gitura, Dayi, Hu, Emmanuel R, Kamanzi, Fathi, Maklady, Golden, Fana, J Antonio, Gonzalez-Hermosillo, John, Musuku, Khawar, Kazmi, Liesl, Zühlke, Lillian, Gondwe, Changsheng, Ma, Maria, Paniagua, Okechukwu S, Ogah, Onkabetse J, Molefe-Baikai, Peter, Lwabi, Pilly, Chillo, Sanjib K, Sharma, Tantchou T J, Cabral, Wadea M, Tarhuni, Alexander, Benz, Martin, van Eikels, Amy, Krol, Divya, Pattath, Kumar, Balasubramanian, Sumathy, Rangarajan, Chinthanie, Ramasundarahettige, Bongani, Mayosi, Salim, Yusuf, T, Mpofu
Rok vydání: 2022
Předmět:
Zdroj: New England Journal of Medicine. 387:978-988
ISSN: 1533-4406
0028-4793
Popis: Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited.We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHAOf 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, -76 days; 95% confidence interval [CI], -121 to -31; P0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, -72 days; 95% CI, -117 to -28). No significant between-group difference in the rate of major bleeding was noted.Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.).
Databáze: OpenAIRE
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