Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve.
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Guimarães Helio P, Lopes Renato D, de Barros E Silva Pedro G M, Liporace Idelzuita L, Sampaio Roney O, Tarasoutchi Flávio, Hoffmann-Filho Conrado R, de Lemos Soares Patriota Rodrigo, Leiria Tiago L L, Lamprea Diana, Precoma Dalton B, Atik Fernando A, Silveira Fabio S, Farias Fabio R, Barreto Diogo O, Almeida Adail P, Zilli Alexandre C, de Souza Neto João D, Cavalcante Margaret A, Figueira Fernando A M S, Kojima Flávia C S, Damiani Lucas, Santos Renato H N, Valeis Nanci, Campos Viviane B, Saraiva Jose F K, Fonseca Francisco H, Pinto Ibraim M, Magalhães Carlos C, Ferreira Joao F M, Alexander John H, Pavanello Ricardo, Cavalcanti Alexandre B, Berwanger Otavio, RIVER Trial Investigators
Аннотация
METHODS: In this randomized trial, we compared rivaroxaban (20 mg once daily) with dose-adjusted warfarin (target international normalized ratio, 2.0 to 3.0) in patients with atrial fibrillation and a bioprosthetic mitral valve. The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months.
RESULTS: A total of 1005 patients were enrolled at 49 sites in Brazil. A primary-outcome event occurred at a mean of 347.5 days in the rivaroxaban group and 340.1 days in the warfarin group (difference calculated as restricted mean survival time, 7.4 days; 95% confidence interval [CI], -1.4 to 16.3; P<0.001 for noninferiority). Death from cardiovascular causes or thromboembolic events occurred in 17 patients (3.4%) in the rivaroxaban group and in 26 (5.1%) in the warfarin group (hazard ratio, 0.65; 95% CI, 0.35 to 1.20). The incidence of stroke was 0.6% in the rivaroxaban group and 2.4% in the warfarin group (hazard ratio, 0.25; 95% CI, 0.07 to 0.88). Major bleeding occurred in 7 patients (1.4%) in the rivaroxaban group and in 13 (2.6%) in the warfarin group (hazard ratio, 0.54; 95% CI, 0.21 to 1.35). The frequency of other serious adverse events was similar in the two groups.
CONCLUSIONS: In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin with respect to the mean time until the primary outcome of death, major cardiovascular events, or major bleeding at 12 months. (Funded by PROADI-SUS and Bayer; RIVER ClinicalTrials.gov number, NCT02303795.).